headaches and migraines Flashcards
acute herpes zoster
=also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox)
symptoms: People with herpes zoster most commonly have a rash in one or two adjacent dermatomes (localized zoster). The rash most commonly appears on the trunk along a thoracic dermatome. The rash is usually painful, itchy, or tingly.
risk factors: Anyone who has had natural infection with wild-type varicella zoster virus (VZV) or had varicella vaccination can develop herpes zoster. people with immunocompromised conditions: cancer, especially leukemia and lymphoma,human immunodeficiency virus (HIV), bone marrow or solid organ (renal, cardiac, liver, and lung) transplant recipients, taking immunosuppressive medications, including steroids, chemotherapy, or transplant-related immunosuppressive medications, women, white people
patho: In immunocompetent patients, specific antibodies (IgG, IgM, and IgA) appear more rapidly and reach higher titers during reactivation (herpes zoster) than during the primary infection causing long-lasting, enhanced, cell-mediated immunity to the varicella-zoster virus.
The dermatological involvement is centripetal and follows a dermatome. In most cases, it is the lumbar and cervical roots that are involved, whereas motor involvement is rare. The infection is contagious to individuals who have no prior immunity to varicella-zoster, however, the rates of transmission are low. The virus can be transmitted either via direct skin contact or by inhaling infected droplets. When virus affects ophthalmic nerve it can cause acute headaches. Or when shingles is on head/ scalp
cervicogenic headaches
=presents as unilateral pain that starts in the neck. It is a common chronic and recurrent headache that usually starts after neck movement. It usually accompanies a reduced range of motion (ROM) of the neck
causes: A cervicogenic headache is thought to be referred pain arising from irritation caused by cervical structures innervated by spinal nerves C1, C2, and C3; therefore, any structure innervated by the C1–C3 spinal nerves could be the source
symptoms: unilateral pain, ipsilateral diffuse shoulder, and arm pain. ROM in the neck is reduced, and pain is relieved with anesthetic blockades.
risk factors: 30-44 YOA
patho: The C1-C3 nerves relay pain signals to the nociceptive nucleus of the head and neck, the trigeminocervical nucleus. This connection is thought to be the cause of referred pain to the occiput and/or eyes. Aseptic inflammation and neurotransmission within the C-fibers caused by cervical disc pathology are thought to produce and worsen the pain in a cervicogenic headache.
temporal arteritis
=a type of vascular inflammatory condition that affects the arteries near the temples of the head that supply the scalp. This usually occurs when the vessels become inflamed or constricted.
caused by: unknown, possibly an autoimmune response
pop: over 50s, more women than men.
s&s: a throbbing, continuous headache. Other symptoms include loss of appetite/weight loss, fatigue, fever, tenderness on the scalp or temples, jaw pain that becomes worse after chewing, muscle aches in the arms, shoulders, hips, thighs, lower back and buttocks, and vision problems e.g., double vision, blurry or transient vision loss which can lead to permanent vision loss if not treated.
patho: Inflammation of medium-large-sized arteries originating from the arch of the aorta is the hallmark of the disease. GCA is characterized by innate and adaptive immune system dysregulation, and the pathophysiology is thought to involve the body’s inappropriate response to vascular endothelial injury. The initial insult to the endothelium (injury, trauma, infection, drug, autoantigen) results in activation of the dendritic cells residing in the adventitia. The activated dendritic cells release chemokines
stroke/ tias
=temporary stroke like symptoms symptoms due to artery blockage and decreased blood to brain
Risks: head trauma, haemorrhage, men, obesity, high cholesterol, high age, hypertension, diabetes, smoking, genetics, contraception, previous tia/ heart conditions, vascular disease
S&s: face unilateral weakness/ palsy, slurred speech, arm weakness, Diplopia, vision disruption, disorientation, seizure, vomiting
patho: The blood flow to the brain is managed by two internal carotids anteriorly and two vertebral arteries posteriorly (the circle of Willis). Ischemic stroke is caused by deficient blood and oxygen supply to the brain; hemorrhagic stroke is caused by bleeding or leaky blood vessels.
Headaches that are brought on by strokes are often sudden and intense. The headache usually happens along with other classic stroke symptoms, like weakness, numbness, dizziness, and slurred speech
migraine’s w aura
= a recurring headache that strikes after or at the same time as sensory disturbances called aura. These disturbances can include flashes of light, blind spots, and other vision changes or tingling in your hand or face.
causes: due to an electrical or chemical wave that moves across the brain. The part of the brain where the electrical or chemical wave spreads determines the type of symptoms you might experience.
symptoms: Migraine aura symptoms include temporary visual or other disturbances that usually strike before other migraine symptoms — such as intense head pain, nausea, and sensitivity to light and sound, Blind spots (scotomas), which are sometimes outlined by simple geometric designs, Zigzag lines that gradually float across your field of vision, Shimmering spots or stars, Changes in vision or vision loss, Flashes of light, Numbness, typically felt as tingling in one hand or on one side of your face that may spread slowly along a limb, Speech or language difficulty, Muscle weakness
risks: family history, women
patho: Neuronal and glial depolarization spreading across the cerebral cortex is thought to cause the aura of the migraine. This activates the trigeminal afferents, which cause inflammatory changes in the meninges, leading to pain.
migraine’s w/o aura
Migraine without aura is a recurrent headache attack of 4 to 72 hours; typically unilateral in location, pulsating in quality, moderate to severe in intensity, aggravated by physical activity, and associated with nausea and light and sound sensitivity (photophobia and phonophobia)
