Headaches Flashcards
what is included within the limbic system
hypothalamus
mammillary bodies
hippocampus
amygdala
arcuate nucleus
what does the limbic system do
help with regulation of emotions, hunger clues, learning/memory
tracts help with memory pathways
what is the function of the thalamus
memory, emotion, behavior
what is the function of the mamillary bodies
part of the hypothalamus
memory consolidation
olfactory reflexes including smell memory
what is the function of the hippocampus
memory processing
what is the function of the amygdala
fear, agression, emotions and olfaction
what is the function of arcuate nucleus
receives signals, helps with feeding ques
what is CN1 for
olfactory - smell
what is CN2
optic - vision
what is CN3 for
oculomotor
eye motion and eye lid movement
what is CN4
Trochlear
superior oblique extra-ocular movement - down and out
what is CN5
Trigeminal
from pons to the face and cranial dura
sensory - helps with 3 regions of sensation
Motor - helps with moving mouth, chewing.
cause for migraines
What is CN6
Abducens
lateral rectus muscle and sensory for proprioception - helps with lateral muscle
what is CN7
facial
Motor: expressions, lacrimal and salivary glands
Sensory: taste buds, anterior tongue
what is CN8
vestibulocochlear
balance and hearing
what is CN9
glossopharyngeal
motor: salivary glands, pharynx and tongue - helps with speech and cough
sensory: to pharynx, posterior tongue and carotid bulb receptor
what is CN10
Vagus
sensory to pharynx
primary efferent parasympathetic nerve that acts on viscer - parasympathetic response
vasovagal syncope
may be triggered by high emotions (such as fear or anxiety, pain
trigger occurs causing the afferent limb of the ANS to be engaged
afferent limb will react - parasympathetic response firing causing decrease HR and BP
what is CN11
accessory nerve
sensation and motor to sternocleidomastoid
muscle of pharynx and larynx
what is CN12
Hypoglossal
motor to tongue and sensory to brain
what are the different types of pain
somatic/cutaneous pain
deep somatic pain
visceral pain
psychogenic pain
what is somatic or cutaneous pain
arises from nociceptive receptors in the skin and mucous membranes
superficial pain
feels like sharp, burning, pricking and is constant
fast or slow onset
what is deep somatic pain
stems from tendons, muscles, joints, periosteum and blood vessels
what is visceral pain
originates from internal organs: pelvis, abdomen, chest and intestines
activates nociceptor of the viscera
poorly localized and is an achy and dull sensation
visceral structures are highly sensitive to stretching, ischemia and inflammation but insensitive to other stimuli that normally provoke pain
what is psychogenic pain
individuals “feel” pain but cause is emotional rather than physical
what is pain associated within the head
traction
inflammation
pressure/displacement of arteries
meningeal irritation
sinus pain
muscle spasms
what is nucal regidity
neck stiffness - meningitis
bend their head down and is causes visceral response
why do headaches occur
due to nociceptive neurons within the trigeminal, vagus or glossopharyngeal cranial nerves within the upper cervical roots becoming depolarized
what are cluster headaches characterized by
deep pain that is burning, stabbing or lancinating pain
pain can be excruciating: patients may even consider suicide
what is the common patient population for cluster headaches
Males > females
autosomal dominant inheritance pattern
1st degree relative cluster headache increases risk by 5-18x
what are risk factors of cluster headaches
tobacco use, family history of headache, head injury, shift work
what are triggers for cluster headaches
sleep apnea, food containing nitrates, nail varnish, petroleum, vasodilators (nitroglycerin, alcohol, histamine)
what is the pathophysiology of cluster headaches
not completely understood but leads to trigeminal activation
functional MRI suggests that hypothalamus involved - opioid system involved and parasympathetic involvement
what are the typical signs of clusterheadaches
lacrimation, ipsilateral forehead or facial flushing or sweating, ipsilateral nasal discharge, affected eye red with dilated conjunctival injection; restlessness and or packing/rocking head in hands
Migraines
lasts 4-72 hours
may or may not have aura
vascular edema
what is scotomata
visual scintillations - transient, fully reversible, colorful flashing lights or dark spots
what is the location of a migrane
unilateral 50% of the time, but can be frontal
what are the characteristics of migraines
pulsating, throbbing headache or dull, ache-type headache
what are provaocative meausures for migraines
physical activity - walking/climbing stairs
what are the positive effects of caffeine
increase attention and alterness, decreased fatigue
lower risk of cardiovascular disease
lower risk of diabetes
increased metabolic rate
what are the negative effects of caffeine
anxiety
increased vasoconstriction and blood pressure
reduced control of fine motor movements
stimulation of urination
what is a tension headache
Aka TTH (tension-type headache)
band headache often associated with neck pain
often associated with muscle spasms
what is a sinus headache
mucosal inflammation of paranasal sinuses and nasal mucosa - typically co-inflamed
sinus ostia irritation and edema
how is the maxillary sinus connected
via hiatus semilunaris at the roof of the sinus
what is sinusitis pathophysiology
most commonly associated with viral URI
edema/inflammation
mucus production
obstruction of sinus outflow tract
stagnant fluid and overgrowth of bacteria
what are the symptoms of sinus headaches
sinus “aching” pain or pressure, increases wtih bending forward, mastication and with bending forwards; purulent discharge or green nasal discharge
what is the most common cause of sinus headache
viral infection - rhinovirus is the msto common
rarely bacterial - 2 weeks of symptoms
what is an exertional headache
brought on by exercise - need to ensure no other underlying pathology
i.e. TBI, CAH, mass, Chiari malformation, pheochromocytoma
what is chiari malformation
congenital deformation condition in which brain tissue extends into the spinal canal. It occurs when part of the skull is misshapen or smaller than is typical, pressing on the brain and forcing it downward
what is a phenochyromocytoma
adrenal tumor - elevates BP due to hormonal changes
what is the pathophysiology of exertional headache
not completely known
1. release of neuroinflammatory chemicals
2. dysregulation of vasoactive neurotransmitters that control pain pathways
what is the presentation of exertional headache
usually unilateral with moderate-to-severe pain that is pulsating in nature - patient may also have N/C=V, scotomas, and photophobia
what is a menstraul headache
estrogen withdrawal and/or prostaglandin release
change in levels - change in neuronal networks associated with pain
trigeminal vascular system activated - proinflammatory changes
what are the symptoms of menstrual headaches
onset 2 days prior to menses and will last until final days of menses
may be acoompanied with fatigue, acne, joint pain, decreased urination, constipation and or lack of coordination
what is an overuse headache
a vicious circle of medication over use - more medications -> more headaches -> more medications -> more headaches
associated with overuse of HA medication - 15+ days per month
what is the pathophysiology of overuse headaches
genetic predisposition
develop central sensitization
with chronic use of medications, there is bigger change in neurotransmitter receptors (decreased inhibitory pathways and increase perceived discomfort)
