2nd semester

Done By:

- Abrar AlMahfoudh. - Najwa AlMahfoudh. - Fatimah Abudeeb.

Revised & organized by: - Kawaii Akuma.

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are extremely rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and occasionally by taking medications.

208 | 5th neurophysiology lecture

Causes of headaches: 1. An overuse of analgesics Chronic Daily Headache. 2. It could be related to meningeal irritation (here you seek a neurologist); so any changes in ICP or even temporary changes in the CSF balance. Balance between formation and the absorption is very delicate; and if this delicate fluid balance is disturbed, even a few extra milliliters of CSF this will cause headache. A headache due to Increase in Intracranial Pressure is associated with projectile vomiting or waking up early in the night. A headache due to meningitis is associated with fever and stiff nick. 3. If youre having a fluid retention the problem will be with the kidney function or a problem with the salt intake or the blood pressure. 4. 5th cranial nerve inflammation: Trigeminal Neuritis, this usually comes when the person is exposed to air current. The patient has lancinating pain which comes and goes along the distribution of trigeminal nerve (Ophthalmic, Maxillary, and Mandibular). 5. Tooth ache and earache. 6. Hypertension and Temporal Arteritis (occurs in elderly patients in which the artery is thickened and felt like a cord). 7. Eye sight and refraction errors or a mass on the optic nerve can lead to headache. 8. Sub-arachnoid hemorrhage as a side effect of using mono-amino oxidase inhibitor "MAOI" for treating Parkinson disease, this will lead to slender clap headache associated with a seizure, personality changes, confusion, or loss of consciousness. 9. Aneurysm rupture: causes a very severe headache. 10. Strenuous exercise or minor trauma. 11. Stroke (causes bleeding ICP or meningeal irritation) due to cerebrovascular accident affecting the cerebral cortex or the internal capsule: leads to loss of function and a headache associated with neurologic symptoms (e.g. weakness, numbness, and impaired vision). In case theres a patient with a headache due to aneurysm rupture, Stroke, strenuous or sub-arachnoid hemorrhage you need to fully investigate him including CAT scan and MRI. The sensory nerves are found in the vessels and the meninges; so stretching the meninges pain, but touching the brain tissue itself will NOT cause pain.

208 | 5th neurophysiology lecture

Types of headaches: Tension Headache: the most common type we get, it happens during working days and is worse by the end of day. It is due to muscle contractions. It is treated by stress management, meditation, massage, relaxation..etc Cluster headache: very severe pain on one side of the head that comes and goes again in clusters. Its sharp, sudden, extremely painful and it occurs several times per day, lasts for months then goes away. However its not associated with tearing or anything else. The patients become restless, irritated, move a lot to forget the pain. Restlessness due to pain (as turning around on bed) might be also due to renal colliculi.

Migraine: severe, recurrent pulsating headaches but not the worst-, predominantly in females; it is related to the cycle and the hormonal changes and water retention. Not all migraines are unilateral! 60% of it is unilateral but 40% is bilateral. Migraine headache comes slowly so theres an OURA (the patients know theyre going into the attack). Causative theories: 1. One theory suggests that it is due to constriction of a scalp blood vessel with proximal dilatation due to serotonin imbalance. 2. Other suggests that the pain is due to the dilatation of the vessels instead of constriction. 3. Other theory relates the environmental conditions to migraine. 4. A new theory says that food allergy (like allergies to chicken & oranges) leads to migraine. Symptoms: Migraine is associated with symptoms like rhinitis, tearing & swelling of the eye, photophobia and phonophobia, nausea and vomiting. The person would like to be secluded alone with the lights off and not listen to anything (avoid any stimulus) and this could continue for 2-3 days. Pain + pulsation + the previous symptoms = migraine Pain + pulsation without the previous symptoms migraine

208 | 5th neurophysiology lecture

What is the problem with migraine? Migraine has to be treated! Because its not only associated with pain; it destroys the neurons too; so if somebody has a chronic migraine thats not treated it might lead to ominous squealae like dementia and loss of cognitive function at the end. Treatment: Migraine treatment involves major medications like anticonvulsants, antidepressants, not PANDOL or PROVIN so the doctor MUSTNT diagnose a patient with migraine unless he is very sure of it. I. When do you treat? Or whatre the criteria for treatment? If the patient has already had 5 attacks at least each lasting for 3 days (72 hrs) with unilateral pulsatile, moderate or severe intensity aggravated by walking or some physical activity, accompanied by tearing, swelling and redness of the eye, nausea, vomiting, photophobia or phonophobia in a completely healthy person then this is diagnosed as migraine. II. Medications: a. Beta blockers (propranolol): Propranolol is given to the patients with palpitation and arrhythmia; however because it can cross BBB it causes depression which is a major side effect especially if the migraine is caused by depression in the first place. Referred headache: It will come from teeth, sinuses, vision & refracted errors, trigeminal nerve or earache. TMJ pain: Clinching too much -while sleeping- on the tempromandibular joint or its dislocation will cause inflammation and crackling sound when moving the joint which will be referred as a headache.

208 | 5th neurophysiology lecture