NEURO-Headache+CASES NEURO Flashcards
Ms. Jackson recently had infection after hitting head in auto accident. What HA is this type?
Secondary Infx MC Trauma Vascular Disorder Subarachnoid hemorrhage SAH Tumor meningitis, cerebral aneurysm
Ms. Sarah c/c of constant, late in day HA, both sides since 2/day. What type of HA?
MC Primary Tension HA
CP- neck to shoulders
Featureless- no assoc sx. KEY is lack of assoc
Vise-like- band around head
TX- analgesic w/ caffeine, ASA, Aceta,
Caution-NSAIDs dt rebound
Chronic- PT, massage, acupunture, ROM, yoga, ergonomics
Are there assoc sx such as photophobia and MSK tensoin with Tension HA?
Rare to have significant MSK tone
NO assoc sx
What are important structures to palpate for HA?
Skin Connective Tissue Aponerusis Loose Connective tissue Pericranium
Nerves- occipital under capitus msk- compression. If MSK tight, HA_Steroid inj help.
What can we assure Pts?
Not a brain phenomenon
BUT dura and vessels
IF HA in the morning w/ waking, OSA, CO, MDD
What concerns and questions should be addressed?
Stress MDD/GAD Posture- INC Cervial arch, INC KYphosis TMJ, teeth grinding F 30s
What is idiopathic and 2nd MCC headache?
MIGRAINES
F, B, <14-18
FHx MC
CP-***UL, throbbing, episodic, waves N/V/A Photophobia-light, phonophopia-sounds, osmophobia-smells VA Gradual- hrs-days Cognitive impaired
What are similarities btwn seizures and Migraines?
Cognitive impairment
Aura- neurologic preceding HA, Pre signals- Migraines Focal neurological deficits-aura
Classic Migraine w/ aura
Ms. Sarah notices her Migraines start often with her cycle? What are other triggers?
Menstruation Catamenial migraine → progesterone HAs
FHx (not really a trigger, but it’s a predisposing factor)
● Stress
● Lack/excess of sleep
● Missed meals
● Foods -chocolate, EtOH, cheese, caffien
● OCP
What is the ideal treatment for Migraine?
Treat early and aggressive w/ large single dose
● Triptans - ex: Sumatriptan + Naproxen
● If no n/v-Acetaminophen q6 hours for 7-10 days
● Narcotics DO NOT work for neuropathic pain.
NSAIDS- ADE rebound headaches.
How should Migaines be explained to someone hurting?
triggers induce neuronal dysfunction that results in a vascular change, ● Regional cerebral blood flow diminished followed by hyperemia → result is pain
- vasoconstriction linked to aura-MC visual-halos, auditory-tinnitus, somatosentory-burning, or motor
- Vasodilation in cerebral arteries= pain menigies
- neurovascular problem- Neuronal hyperexcitability/vasoconstriction on EEG.
4.cortical spreading depression/vasodilation
● vasodilation CN V– carries impulse that l/t washout when brain is super active.
Mr. Harris 40y M,had a sudden HA qod 5 hrs. C/c HA is severe *around his R eye. His eye is drooping. He is unable to sleep. What is this HA?
Cluster HA- trigeminal autonomic cephalgia Explosive sound-Shotgun to head sound Episodic- rapid Insomnia No FH
Cluster HA have a connection w/ what syndrome
Horners- anhydrous, ptosis, miosis-constricted SNS dfx, w/ parasympathetic activation ANS s/s: 1. Teary red eye 2. Swollen drop lid-ptosis 3. Constricted pupil-miosis 4. Sweat skin- 4. Rhinnorhea
What triggers cluster HA?
EtOH Stress Glare foods - spicy* SAH DDX**Analgesia rebound DDX**Giant Cell temporal arteritis Trauma Mass
How do Cluster HA occur?
Hemodynamic-dilation
Trigger stimulate PNS tract
Trigeminal Nerve (substance P fibers carry sympathetic information in CNVI,II,
Somatostatin inhibits and reduces intensity/duration of HA Ipsilateral hypothalamus implicated – circadian same time often
