sakit sa ulo

Question 1

define headache

Answer 1

pain or discomfort over upper head - orbits to suboccipital

Question 2

general mechanisms of headache

Answer 2

traction, distention or dilation of intracranial vessels

inflammation near pain sensitive structures

direct pressure on cranial/cervical nerves

sustained contraction of scalp or neck muscles

stim from disease of EEN and sinuses

Question 3

give pain sensitive structures

Answer 3

cranial venous sinus

arteries at base of brain and dura

dura near base of brain and large arteries

all extracranial structures

Question 4

give pain insensitive structures

Answer 4

brain parenchyma

ependyma

choroid pleus

pia, arachnoid and dura over convexity

skull

Question 5

what is brain parenchyma

Answer 5

brain functional tissues in the brain made up of neurons and glial cells

Question 6

what is ependyma

Answer 6

membrane of glial cells lining the ventricles and central canal of the spinal cord

Question 7

discuss primary HA

Answer 7

no underlying cause

migraine, tension and cluster

Question 8

diff migraine HA vs tension-type HA

Answer 8

migraine: pain, nausea and visual changes on one side and loc varies

tension-type - like a band squeezing head (B); may radiate to neck and shoulder

Question 9

discuss cluster HA

Answer 9

pain is in and around one eye

Question 10

discuss secondary HA

Answer 10

with an underlying cause:
- CNS infection
- neoplasm
- CV diseases
- sinusitis

Question 11

discuss sinus HA

Answer 11

pain is behind brow bone and/or cheekbones

frontal and maxillary sinuses

triggered by sinusitis - inflammation of sinuses

Question 12

what is the most common type of primary HA

Answer 12

tension but migraine is often discussed

Question 13

importance of HA to neuro diagnosis

Answer 13

HA alarms - may be considered life threatening

Question 14

HA red flags

Answer 14

sudden or new onset

wakes pt from sleep

assoc c/:
- vomiting
- visual sx
- weakness/numbness
- meningeal irritation

Question 15

HA diagnostic alarms

Answer 15

onset after 50 yo

sudden on set

inc freq and severity

new onset c risk for HIV/cancer

assoc c systematic illness

altered consciousness or focal neuro deficits

papilledema

significant trauma

Question 16

danger signs of HA

Answer 16

severe and progressive

alteration of consciousness; sudden explosive

fever and neck rigidity

double vision or CN involvement

papilledema

other focal neuro deficits

Question 17

exp vascular theory of migraine

Answer 17

vasoconstriction - reduced BF - cerebral hypoxia - abnormal brain activity - aura - HA

Question 18

exp neuronal/nuerogenic inflammatory theory

Answer 18

CN V initiate and promote tissue inflaam - TGMV conveys pain = vasodialtion and local edema = pain

Question 19

discuss neurovascular theory

Answer 19

trigger factors can stim diff structures - activates certain parts = vasocontriction - lack of O2, abnormal fucntion and aura = HA

also activates CN V = inc BV permeaability to proteins - build up of fluid - inflamm = turnover of 5-HT

depletion of 5-HT = HA

Question 20

discuss the migraine pathophysiology

Answer 20

HA is both vascular and neural problem

lack of BF and disturbance of serotonergic system

Question 21

emotion and stress triggers

Answer 21

cerebral cortex

Question 22

thalamus is triggered by

Answer 22

bright lights, noises and smells

Question 23

hypothalamus is triggered by

Answer 23

internal bodily environment and mechanisms

Question 24

vasodilator triggers

Answer 24

carotid vessels

Question 25

migraine vs tension HA in terms of duration

Answer 25

migraine: 5 attacks lasting 4-72 hrs

tension: 10 attacks lasting 30 mins-7days

Question 26

migraine vs tension HA in terms of character

Answer 26

migraine: unilat, throbbing, mod-severe; inhibits/prohibits work and worsened by activity

tension: bilat, not throbbing, mild-mod; no effect or may inhibit work and not worsened by activity

Question 27

migraine vs tension HA in terms of assoc sx

Answer 27

migraine: nausea, photophobia and phonophobia

tension: (-) nausea; but can have photophobia or phonophobia or neither