Neurophysiology 5th Lecture

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.

Neurophysiology 5th Lecture

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