1. Neurology
Lecture 4a
Headaches

2. Headaches Cephalgia The skull and brain tissue are not capable of
Sensory pain

3. Headaches: Pathophysiology
Where does the pain arise from?
Scalp
Dura mater
Blood vessels
Cervical & cranial nerves
Dilate
Become congested 
Pain

4. Classifications of Headaches
Primary headache
(no organic cause)
Migraine
Tension
Cluster

5. Headache Assessment
Factors that precipitate, provoke, intensify, diminish
Description
Dx testing
Not helpful

6. Migraine Description Primarily a vascular disturbance Recurrent
F vs M?
Female > Male
Familial tendencies

7. Migraine: pathophysiology
H/A is proceeded by h in serotonin level 
Vaso constriction 
i in serotonin level 
Vaso dilitation 
PAIN
Migraine H/A are caused by constriction blood vessels in the brain followed by dilation

8. Migraine: etiology / triggers
Menstrual cycles
Lights
Meds
MSG
Nitrates
Milk
Chocolate
ETOH
Oral contraceptives

9. Migraine: Clinical manifestations
Prodromal phase
Duration
Hrs – days before H/A
S&S
Depression
Irritability
Cold
Cravings
Anorexia
(Same)

10. Migraine: Aura Phase Duration S&S < 1 hr
Focal neurologic symptom / sensory manifestation
Lights flashing
Spots
Numbness
Confusion
Weakness
dizzy

11. Migraine Aura phase Pathophysiology Painless vasoconstriction
i cerebral blood flow

12. Migraine: H/A phase Headache Phase Duration Pathophysiology 4-72 hours
Vasodilatation
i serotonin level

13. Migraine: Headache Phase
S&S
Unilateral
Throbbing
Severe / incapacitating
Photophobia
N&V
Physical exerting  h

14. Migraine: Recovery Phase
Pain
Subsides
Tenderness
Neck & scalp
Exhaustion

15. Migraine: treatment Imitrex (sumatriptan) Action Serotonin agonists
Vasoconstriction
i inflammation

16. Migraine: treatment Ergotamine Tartrate Cafergot Take early Action
Smooth muscle constriction or cerebral blood vessels
Cafergot
Ergotamine Tartrate + ?
Caffeine
i severity of the attack

17. Migraine: treatment Inderal Beta-blocker Action Use Duration of med
Inhibit dilatation of the blood vessel
Use
Prevention
Duration of med
3-6 months  tapper

18. Migraine: treatment
Avoid Triggers

19. Cluster Headaches Clinical Manifestations Unilateral Come in clusters
1-8 day
Pain localize to the
Eye & orbit
And radiating to the
Facial & temporal regions

20. Cluster Headaches: clinical manifestation cont.
Pain accompanied with
Watering eyes
Nasal congestion
Duration
30-90 min
Female vs Male ?
F < M

21. Cluster Headaches
Triggers
Alcohol
Nitrates
Vasodilators
Histamines

22. Cluster Headaches
Treatment O2
Ergotamine Tartrate

23. Tension Headaches Define
Emotional or physical stress  constriction of the muscles in the neck & scalp

24. Tension Headaches Clinical Manifestations Steady constant pressure
Forehead, temples of back of neck
Band or weight on head

25. Tension Headaches
Associate with
PMS
Stress
Anxiety
Depression

26. Tension Headaches Treatment Heat Massage Analgesics Antidepressants
Muscle relaxants
Relaxation
Rest