HEADACHES Flashcards
PAIN SENSITIVE CRANIAL STRUCTURES
1) skin, subcutaneous tissue, muscles, ___________ of the skull;
(2) the
delicate structures of the eye, ear, nasal cavities, and paranasal
sinuses;
(3) ___________ because they are intradural
extracranial
arteries, and external periosteum
intracranial venous sinuses and their
large tributaries
(4) parts of
the dura at the ______________
the dura, particularly the ________________ and the intracranial segment
of the internal carotid artery; (5) the middle meningeal
and __________; and (6) the first three
cervical nerves and cranial nerves as they pass through
the dura.
base of the brain and the arteries within
proximal parts of the anterior
and middle cerebral arteries
superficial temporal arteries
Much of the __________________ and choroid plexuses lack sensitivity.
pia-arachnoid, the parenchyma of the brain,
and the ependyma
Pain that arises from distention of the
middle meningeal artery is projected to the __________
back of the
eye and temporal area.
Pain from the intracranial segment
of the internal carotid artery and proximal parts
of the middle and anterior cerebral arteries is felt in the
_______
eye and orbitotemporal regions.
The sphenopalatine branches of the facial
nerve convey impulses from the _______
nasoorbital region
The
ninth and tenth cranial nerves and the first three cervical
nerves transmit impulses from the ___________
inferior surface of
the tentorium and all of the posterior fossa.
To summarize, pain from supratentorial structures
is referred to the anterior two-thirds of the head, i.e., to
the territory of sensory supply of the_______________;
pain from infratentorial
structures is referred to the vertex and back of the head
and neck predominantly by the__________
first and second
divisions of the trigeminal nerve
second cervical roots.
The _____________
cranial nerves refer pain to the nasoorbital region, ear,
and throat
seventh, ninth, and tenth
Dental or temporomandibular
joint pain impulses are carried by the _____________
second and third
divisions of the trigeminal nerve
most patients with high intracranial pressure complain
of _____________ headaches that fluctuate in
severity, probably because of traction on vessels or dura.
bioccipital and bifrontal
The headaches that
follow seizures and ingestion of alcohol are probably all
caused by _________
cerebral vasodilatation.
increased _____________activates pain-sensitive structures
within their walls or around the base of the brain
pulsation
of meningeal vessels
A similar mechanism may be operative in the severe,
bilateral, throbbing headaches associated with ________________in blood pressure, as occurs with pheochromocytoma,
malignant hypertension, sexual activity, and
in patients being treated with monoamine oxidase inhibitors.
extremely
rapid rises
Activation of the
_______________ (the trigeminal nerves and the
blood vessels they supply), leading to an inflammatory
response that is generated by local neural mechanisms,
_______________” has also been assigned a role
in migraine headache.
trigeminovascular system
“neurogenic inflammation,
With regard to cerebrovascular diseases causing
head pain, the ______ AND ____________
when involved in giant cell arteritis (cranial or “temporal”
arteritis), give rise to severe, persistent headache,
at first localized on the scalp and then more diffuse
extracranial temporal and occipital arteries,
basilar artery thrombosis causes pain
to be projected to the _______
occiput and sometimes to the forehead;
Expanding or ruptured
intracranial aneurysms of the _________________ very often cause pain
projected to the eye.
posterior communicating
or distal internal carotid arteries
Infection or blockage of paranasal sinuses is accompanied by pain over the affected_____________
Usually it is associated with tenderness of the skin and
cranium in the same distribution
maxillary or frontal sinuses.
With _________, the pain tends
to be worse on awakening and gradually subsides when the patient is upright;
the opposite pertains with __________sinusitis
pain is ascribed
to __________ and its relief to their emptying,
induced by the dependent position of the ostia.
frontal and ethmoidal sinusitis
maxillary and sphenoidal
filling of the sinuses
When
_________ causes headache, the sclera
is invariably red.
Dilating the pupil risks precipitating
IT, a situation that can be reversed
by the administration of __________
acute angle closure glaucoma
pilocarpine 1 percent drops
Headaches that accompany disease of ligaments, m uscles,
and apophysial joints in the upper part of the cervical spine
are referred to the ______________on the
same side and sometimes to the__________
occiput and nape of the neck
temple and forehead.
The pain
of _____________ a controversial entity, is characterized
by tender areas near the cranial insertion of cervical and
other muscles.
fibromyalgia,
The______________(usually due to
infection or hemorrhage) is typically acute in onset, usually
severe, generalized, deep seated, constant, and associated
with stiffness of the neck, particularly on forward
bending.
headache of meningeal irritation
dilatation and inflammation of meningeal
vessels and the chemical irritation of pain receptors
in the large vessels and meninges by endogenous chemical
agents, particularly _________________, are
probably more important factors in the production of
pain and spasm of the neck extensors
serotonin and plasma kinins
__________________characterized by a
steady occipitonuchal and frontal pain coming on within
a few minutes after arising from a recumbent position
(orthostatic headache) and is relieved within a minute
or two by lying down.
Its cause is a persistent leakage
of CSF into the lumbar tissues through the needle track
installation of
an _____________relieves the headache.
Lumbar puncture (LP) or spontaneous low CSF pressure headache
epidural “blood patch”
___________
headache may follow a cough, sneeze, strain,
or athletic injury, sometimes as a result of rupture of the
arachnoid sleeve along a nerve root
“Spontaneous” lowpressure
The headache of ____________
when it occurs, is dull and unilateral, perceived over
most of the affected side of the head
subdural hematoma,
The ratio of classic to common
migraine is _____________.
1 :5
Migraine with
aura is ushered in by a disturbance of nervous function,
most often ________ followed in a few minutes to hours
by hemicrania! (or, in about one-third of cases, bilateral)
headache, nausea, and sometimes vomiting, all of which
last for hours or as long as a day or more
visual,
The __________
and the ___________aspects of migraine are
its most characteristic features in comparison to other
headache types.
hemicrania
throbbing (pulsating)
Migraine may have its onset in childhood but usually
begins in adolescence or young adulthood; in more than
80 percent of patients, the onset is before _________ years of
age,
30
Migraine tends to cease during
the second and third trimesters of pregnancy in
________ percent of women,
75 to 80
Although migraine commonly diminishes in severity
and frequency with age, it may actually ____________ in some postmenopausal women, and ______ therapy may
either increase or, paradoxically, diminish the incidence
of headaches
worsen
estrogen
Migraine with aura frequently has its onset soon
________, but it may occur at any time of day
after awakening
The visual or neurologic symptoms usually last for
less than ______
30 min, sometimes longer.
a migrainous personality
existed, characterized by _____________
tenseness, rigidity of
attitudes and thinking, meticulousness, and perfectionism
There may be associated vertigo,
staggering, incoordination of the limbs, dysarthria, and
tingling in both hands and feet, and sometimes around
both sides of the mouth. These symptoms last 10 to 30
min and are followed by headache, which is usually
occipital
Exceptionally; there is an
alarming period of coma or quadriplegia
basilar migraine
recurrent unilateral
headaches associated with weakness of extraocular
muscles. A transient third-nerve palsy with ptosis, with
or without involvement of the pupil, is the usual picture;
rarely, the sixth nerve is affected
The ocular paresis often outlasts the
headache by days or weeks; after many attacks, a slight
mydriasis and, rarely, ophthalmoparesis may remain
permanently.
O p ht h a l m o p l e g i c a n d Reti n a l M i g ra i n e
_______ of almost any degree may precipitate a
migraine headache in persons prone to the condition
Although a family
history of migraine is frequent in such cases, there has
been no history of hemiplegia in other family members.
Cranial trauma
Migraine symptoms in young children
Instead of complailling of headache, the child appears
limp and pale and complains of abdominal pain
a condition
mostly of infants and children (rarely adults), there
are episodes of unilateral paralysis that may long outlast the headache.
mutation for familial hemiplegic migraine
A second locus is in the
gene for the Na+/K+-adenosine triphosphatase (ATPase)
channel and a rarer subtype is caused by mutations in a
sodium channel a.-subunit gene, _________
hemiplegic migraine
the most common
one is in the gene coding for the P /Q-type calcium
channel a. subunit (CACNAlA).
SCNA1
Indeed, there are shared traits between some of the
genetic forms of familial hemiplegic migraine and both
_________________
episodic and degenerative cerebellar diseases
Rarely, migrainous neurologic symptoms, instead of
being transitory, leave a prolonged or even permanent
deficit (e.g., homonymous hemianopia), indicative of an
ischemic stroke. This has been called ________and a small number of these prove to be __________.
complicated migraine
migrainous infarctions
_______________________________________(on rather uncertain grounds) in the pathogenesis
of arterial occlusion and strokes that complicate migraine
Platelet aggregation, edema of the arterial wall,
increased coagulability, dehydration from vomiting, and
intense, prolonged spasms of vessels have all been implicated
In children and young adults with the _____________and in adults with the rare cerebral vasculopathy ___________________________ migraine may
be a prominent feature
mitochondrial disease MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes)
CADASIL
(cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy),
_____________ has been especially associated with
an open foramen
Migraine with aura
migraine that lapses into a condition of daily or virtually severe continuous
headache _________
(status migrainosus).
One-quarter of this group had a history of past migraine and a similar number had a viral-like illness within 3 weeks of the neurologic problem. The CSF contained from 10 to 760 lymphocytes per cubic millimeter, and the total protein was
elevated.
The transient neurologic deficits were mainly
sensorimotor and aphasic; only 6 patients had visual
symptoms. The patients were asymptomatic between
attacks and in none did the entire illness persist beyond
7 weeks
Headache with Neurological Deficits
and CSF Lymphocytosis
