Neurology
Lecture 4a
Headaches
Headaches
• Cephalgia
– Headache
• The skull and brain tissue
are not capable of
– Sensory pain
Headaches: Pathophysiology
• Where does the pain
arise from?
–
–
–
–
Scalp
Dura mater
Blood vessels
Cervical & cranial nerves
• Blood vessels
– Dilate
• Become congested 
• Pain
Classifications of Headaches
•
Primary headache
•
(no organic cause)
1. Migraine
2. Tension
3. Cluster
Headache Assessment
• Factors that precipitate,
provoke, intensify,
diminish
• Description
• Dx testing
– Not helpful
Migraine
• Description
– Primarily a vascular
disturbance
– Recurrent
– F vs M?
• Female > Male
– Familial tendencies
Migraine: pathophysiology
• H/A is proceeded by h in
serotonin level 
• Vaso constriction 
• i in serotonin level 
• Vaso dilitation 
• PAIN
• Migraine H/A are caused by
constriction blood vessels in
the brain followed by dilation
Migraine: etiology / triggers
•
•
•
•
•
•
•
•
•
Menstrual cycles
Lights
Meds
MSG
Nitrates
Milk
Chocolate
ETOH
Oral contraceptives
Migraine: Clinical manifestations
• Prodromal phase
– Duration
• Hrs – days before H/A
– S&S
•
•
•
•
•
•
Depression
Irritability
Cold
Cravings
Anorexia
(Same)
Migraine:
• Aura Phase
– Duration
• < 1 hr
– S&S
• Focal neurologic symptom /
sensory manifestation
–
–
–
–
–
–
Lights flashing
Spots
Numbness
Confusion
Weakness
dizzy
Migraine
• Aura phase
– Pathophysiology
• Painless vasoconstriction
• i cerebral blood flow
Migraine: H/A phase
• Headache Phase
– Duration
• 4-72 hours
– Pathophysiology
• Vasodilatation
• i serotonin level
Migraine: Headache Phase
• S&S
–
–
–
–
–
–
Unilateral
Throbbing
Severe / incapacitating
Photophobia
N&V
Physical exerting  h
Migraine: Recovery Phase
• Recovery Phase
– Pain
• Subsides
– Tenderness
• Neck & scalp
– Exhaustion
Migraine: treatment
• Imitrex (sumatriptan)
– Action
• Serotonin agonists
• Vasoconstriction
• i inflammation
Migraine: treatment
• Ergotamine Tartrate
– Take early
– Action
• Smooth muscle
constriction or cerebral
blood vessels
• Cafergot
– Ergotamine Tartrate + ?
• Caffeine
– i severity of the attack
Migraine: treatment
• Inderal
– Beta-blocker
– Action
• Inhibit dilatation of the
blood vessel
– Use
• Prevention
– Duration of med
• 3-6 months  tapper
Migraine: treatment
• Avoid Triggers
Cluster Headaches
• Clinical Manifestations
– Unilateral
– Come in clusters
• 1-8 day
– Pain localize to the
• Eye & orbit
– And radiating to the
• Facial & temporal regions
Cluster Headaches:
clinical manifestation cont.
• Pain accompanied with
– Watering eyes
– Nasal congestion
• Duration
– 30-90 min
• Female vs Male ?
– F<M
Cluster Headaches
• Triggers
–
–
–
–
Alcohol
Nitrates
Vasodilators
Histamines
Cluster Headaches
• Treatment
– O2
– Ergotamine Tartrate
Tension Headaches
• Define
– Emotional or physical
stress  constriction of
the muscles in the neck &
scalp
Tension Headaches
• Clinical Manifestations
– Steady constant pressure
– Forehead, temples of back
of neck
– Band or weight on head
Tension Headaches
• Associate with
–
–
–
–
PMS
Stress
Anxiety
Depression
Tension Headaches
• Treatment
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Heat
Massage
Analgesics
Antidepressants
Muscle relaxants
Relaxation
Rest