8/4/2019 Neurophysiology 5th Lecture
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2nd semester
Done By: - Abrar AlMahfoudh.
- Najwa AlMahfoudh.
-Fatimah Abudeeb.
Revised & organized by: - Kawaii Akuma.
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208 | 5th
neurophysiology lecture
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.
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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 extramilliliters 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 meningitisis associated with fever and stiff nick.
3. If youre having a fluid retentionthe problem will be with the kidney function or aproblem with the salt intake or the blood pressure.
4. 5th cranial nerve inflammation: Trigeminal Neuritis, this usually comes when the personis 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 acheand earache.6. HypertensionandTemporal Arteritis(occurs in elderly patients in which the artery is
thickened and felt like a cord).
7. Eye sight and refraction errorsor a mass on the optic nervecan lead to headache.8. Sub-arachnoid hemorrhageas 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 bleedingICP 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.
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Types of headaches:
Tension Headache:the most common type we get, it happens during working days and is worseby 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 inclusters. 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 infemales; 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 ofconstriction.
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
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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 attacksat 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 asmigraine.
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.