Headaches and Epilepsy Flashcards
4 types of headaches
Tension, cluster, migraine, sinus
Primary headache
Headaches are classified as either primary (when they are not caused by something else).
A primary headache is likely due to pain sensing nerves, muscles, blood vessels, or changes in chemical activity:
migraines, tension, and cluster headaches are good examples.
How do we treat tension headaches
Most are easily treated with over-the- counter (OTC) medications, including:
• Aspirin, ibuprofen or paracetamol
• Daily prescription medications, including tricyclic antidepressants, may manage tension-type headaches.
Alternative therapies aimed at stress reduction may help. They include:
• Meditation, relaxation training
• Cognitive behavioural therapy
• Biofeedback
• Massage and gentle neck stretches
• Heat therapy (warm compress or shower)
What causes migraines
Migraines may be caused by changes in the blood vessels of the brain stem and their interactions with the trigeminal nerve.
Imbalances in serotonin, which helps regulate pain, may be involved.
Serotonin levels may decrease during a migraine - this causes the trigeminal nerve to release neuropeptides, which come into contact with the meninges, resulting in migraines.
Triggers: stress, fatigue, anxiety, changes in altitude, hormonal changes, environmental changes
How do we treat migraines
Migraine treatment is aimed at relieving symptoms and preventing additional attacks.
Treatments may include:
• Rest in a quiet, dark room
• Hot or cold compresses to your head or neck
• Massage and small amounts of caffeine
• Over-the-counter medications such as ibuprofen, paracetamol, and aspirin
Prescription medications such as triptans, e.g. sumatriptan and zolmitriptan (serotonin agonists) which cause cranial vasoconstriction, reduce blood flow and inflammation.
Preventive medications, e.g. propranolol (beta blockers which dilate blood vessels – unclear how this helps!), amitriptyline (TCA) or topiramate (antiseizure).
Secondary headaches
Secondary headaches are caused by something else, which activates the pain-sensing nerves of the head. Thus, headaches can be a symptom of something very serious, and if headaches are persist, increase in intensity, or are regular, they should be checked.
A wide range of possible causes with varying severity.
Causes of secondary headaches: dehydration, concussion, influenza, glaucoma, meningitis, brain aneurysm
What is epilepsy
Group of >55 subtypes of disease characterized by unprovoked and provoked recurring seizures. A seizure is hypersynchronous hyperexcitability of groups of neurons, starting from a focus. The membrane potential of these cells may be more depolarised than usual, meaning they fire action potentials more readily.
Diagnosis by EEG
Seizure classification
Seizures can be:
Generalized (involving both cerebral hemispheres and is often a genetic disorder): tonic, clonic and absence
Partial (focal): simple partial and complex partial
(simultaneous firing of a group of neurons “epileptic focus“)
- often caused by focal trauma (acquired epilepsies)
Generalised seizures: tonic - conic (grand mal)
• Tonic phase: (tonic seizures consist of strong contraction of whole body musculature – all muscles stiffen)
– initial strong contraction of whole musculature, cry or groan, loss of consciousness, stop of respiration; salivation, sometimes loss of bladder (rarely bowel) control
• Clonic phase:
– violent, synchronous jerks (clonic seizures), can last several minutes
• Injuries can occur (from objects around the seizing patient, tongue biting, falling)
• Slow recovery (regaining of consciousness), confusion, drowsiness
• Tonic or clonic seizures can occur by themselves as well.
Generalised seizure: absence seizures (petit mal)
• Typically in childhood or teens • Sudden loss of consciousness, but intact control of musculature • Usually short (1-15 sec); recurs often (up to hundred times);
- Symptoms: staring, fluttering of eyes, during longer seizures: automatisms (such as lip smacking, picking at clothes, fumbling);
- Patient then resumes previous activity
- Amnesia; no recollection of event.
- It is as though the youth is „absent“ for a few seconds.
Partial seizure
Focal seizures are initiated by simultaneous firing of a group of neurons in the brain (epileptic focus).
– The site of pathological discharge determines the symptoms (e.g. motor vs. sensory cortex).
– Focal high-frequency discharges of impulses can spread to other areas in the brain (generalisation) and whole body can get involved.
Simple partial:
Preserved awareness, memory & consciousness
Complex Partial: If any of the above are impaired.
Most common in adults.
Partial seizures - causes?
– anoxia or hypoglycemia during and after birth
– infections (meningitis), fever (in children)
– brain trauma (in young adults, accidents)
– drug abuse (e.g. cocaine overdose, withdrawal from ethanol in alcoholics)
– lack of sleep, flashing lights
– tumours, stroke
– drugs: theophylline/ caffeine, amphetamines, penicillin
– often unknown causes
Simple partial seizures
Signs and symptoms:
Frontal lobe - motor signs such as twitching or stiffness
Parietal lobe - burning/tingling/numbness
Occipital lobe - visual disturbances/hallucinations
Temporal lobe - deja vu, unusual taste/smell, feeling of fear
The partial seizure experience depends on the seizure focus and the extent of the seizure spread.
• Motor seizures – within motor cortex or processing centres;
• Sensory seizures: abnormal gustatory, olfactory, auditory, visual sensations – odd sensations, etc.
Complex partial seizure
- Consciousness impaired during seizure but postural control retained
- … most often originate in temporal lobe (e.g. hippocampus, amygdala)
- Stereotypical behaviour during seizure, post-seizure amnesia: don‘t remember seizure
- Often resistant to drug treatment.
Impairment of consciousness: cognitive, affective symptoms
Dreamy state, blank, vacant expressions
Formed auditory hallucinations (hears music)
Formed visual hallucinations (sees house/tree that isn’t there)
Olfactory hallucinations: bad/unusual smells
Psychomotor phenomena: chewing movements, wetting lips, automatisms
Dysphasia
Status epilepticus (SE)
One continuous seizure for > 30 minutes or 2 or more sequential seizures without full recovery of consciousness
Convulsive SE: life threatening – mortality ~ 30 %
̈ Children lower mortality
̈ Elderly up to 80% mortality
