sakit sa ulo Flashcards
define headache
pain or discomfort over upper head - orbits to suboccipital
general mechanisms of headache
traction, distention or dilation of intracranial vessels
inflammation near pain sensitive structures
direct pressure on cranial/cervical nerves
sustained contraction of scalp or neck muscles
stim from disease of EEN and sinuses
give pain sensitive structures
cranial venous sinus
arteries at base of brain and dura
dura near base of brain and large arteries
all extracranial structures
give pain insensitive structures
brain parenchyma
ependyma
choroid pleus
pia, arachnoid and dura over convexity
skull
what is brain parenchyma
brain functional tissues in the brain made up of neurons and glial cells
what is ependyma
membrane of glial cells lining the ventricles and central canal of the spinal cord
discuss primary HA
no underlying cause
migraine, tension and cluster
diff migraine HA vs tension-type HA
migraine: pain, nausea and visual changes on one side and loc varies
tension-type - like a band squeezing head (B); may radiate to neck and shoulder
discuss cluster HA
pain is in and around one eye
discuss secondary HA
with an underlying cause:
- CNS infection
- neoplasm
- CV diseases
- sinusitis
discuss sinus HA
pain is behind brow bone and/or cheekbones
frontal and maxillary sinuses
triggered by sinusitis - inflammation of sinuses
what is the most common type of primary HA
tension but migraine is often discussed
importance of HA to neuro diagnosis
HA alarms - may be considered life threatening
HA red flags
sudden or new onset
wakes pt from sleep
assoc c/:
- vomiting
- visual sx
- weakness/numbness
- meningeal irritation
HA diagnostic alarms
onset after 50 yo
sudden on set
inc freq and severity
new onset c risk for HIV/cancer
assoc c systematic illness
altered consciousness or focal neuro deficits
papilledema
significant trauma
danger signs of HA
severe and progressive
alteration of consciousness; sudden explosive
fever and neck rigidity
double vision or CN involvement
papilledema
other focal neuro deficits
exp vascular theory of migraine
vasoconstriction - reduced BF - cerebral hypoxia - abnormal brain activity - aura - HA
exp neuronal/nuerogenic inflammatory theory
CN V initiate and promote tissue inflaam - TGMV conveys pain = vasodialtion and local edema = pain
discuss neurovascular theory
trigger factors can stim diff structures - activates certain parts = vasocontriction - lack of O2, abnormal fucntion and aura = HA
also activates CN V = inc BV permeaability to proteins - build up of fluid - inflamm = turnover of 5-HT
depletion of 5-HT = HA
discuss the migraine pathophysiology
HA is both vascular and neural problem
lack of BF and disturbance of serotonergic system
emotion and stress triggers
cerebral cortex
thalamus is triggered by
bright lights, noises and smells
hypothalamus is triggered by
internal bodily environment and mechanisms
vasodilator triggers
carotid vessels
migraine vs tension HA in terms of duration
migraine: 5 attacks lasting 4-72 hrs
tension: 10 attacks lasting 30 mins-7days
migraine vs tension HA in terms of character
migraine: unilat, throbbing, mod-severe; inhibits/prohibits work and worsened by activity
tension: bilat, not throbbing, mild-mod; no effect or may inhibit work and not worsened by activity
migraine vs tension HA in terms of assoc sx
migraine: nausea, photophobia and phonophobia
tension: (-) nausea; but can have photophobia or phonophobia or neither
