Headache Flashcards
If the brain does not have pain receptors, what causes the pain?
- meninges - inflammation due to meningitis.
- blood vessels - stretching/traction or distension of arteries.
- skull - sinusitis or dental problems
- muscles - the head and neck (e.g. increased muscle tension d/t TMJ)
Which nerve transmits most pain signals in the head and where does it synapse?
The trigeminal nerve.
Synapse at the brainstem.
Pain signals from the back of the head and the posterior fossa (base) of the skull are transmitted by the…
First three cervical spinal nerves.
Synapse at the brainstem.
Describe the role of second and third order neurons.
2nd order neurons = project to the thalamus then…
3rd order neurons = to the somatosensory cortex
Define primary and secondary headaches.
Primary = not caused by another disorder. Chronic and recurring.:
- migraine
- tension-type headache
- cluster-type headache
- other
Secondary = caused by another disorder so headache is a symptom:
- trauma/injury
- vascular disorder
- substance use/withdrawal etc.
What are temporomandibular disorders (TMD)?
- Caused by teeth grinding, trauma, disc displacement, degeneration (arthritis)
- headache increases with jaw movement (chewing, grinding, clenching)
- joint inflammation spreads to affect nearby muscles and fascia
Describe the pathopysiology of secondary headache.
- irritation, ischemia or stretching of pain-sensitive structures around the brain (meninges and vessels)
- or pain-sensitive structures around the head (muscle, bone, peripheral nerve, join, sinus)
What could a sudden onset (thunderclap - max intensity <1 min) headache signal?
Subarachnoid hemorrhage.
What could a new onset headache in >50 year old signal?
Brain tumor
What could focal neurological deficits lasting >1 hour signal?
CVA
What could new headache with stiff neck, fever, or rash indicate?
meningitis
What could headache with papilledema or decreased LOS indicate?
Increased ICP
What could headache triggered by sneezing, coughing or straining indicate?
Chiari malformation (the cerebellum bulges through a normal opening in the skull where it joins the spinal canal).
Describe the characteristics of a tension headache.
- most common
- bilateral
- steady pressing, tightening, bandlike quality
- mild to moderate severity
- duration: 30 mins - several days
- photophobia OR phonophobia NOT both
Pericranial and/or nuchal muscle tenderness (detected by palpation) often accompanies what type of headache?
Tension type headaches. (TTH)