Headache Describe an approach to the classification of headaches, and list the main causes in each group Chronic, continual Tension headache Analgesic- dependent headache Chronic, episodic Migraine Cluster headache Subspace, evolving Raised interracial pressure Meaning-encephalitis Giant cell arthritis Acute, severe Subtractions hemorrhage Describe the clinical features of migraine and tension type headaches Migraine Repeated episodes of moderate or severe throbbing pain lasting 4-rah Often unilateral, aggravated by movement
Nausea and vomiting Photographic Phonologic Visual disturbance- blurred vision or an arc of scintillating zigzags slowly spreading across the visual field Pallor Common aura symptoms include: visual disturbances – such as flashing or flickering lights, zigzag lines, blurred vision, temporary blindness numbness or a tingling sensation – common in the hands, arm or face, similar to ‘pins and needles’ slurred speech poor concentration problems with your co-ordination Tension headaches Bilateral – band like non-pulsate headache В± muscle tenderness o vomiting or sensitivity to head movement tight band around head, often radiating into the neck- due to chronic contraction of facial and neck muscles. Describe the pathogenesis of migraine The cause of migraine remains controversial. The headache is due to vacillation or extramarital mingle arteries.
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Release of evocative substances such as NO, 5- hydrogenation’s, and the unreceptive calculation-gene-related peptide (CARP) are all thought to play a role in the pathogenesis. Describe the mechanism of action and main side effects of drugs used to treat an cute migraine attack Simple analgesia – acetaminophen, nonessential anti- inflammatory drugs (Nasals), paramedical pain relief. Side effects: nausea and vomiting Antithetic e. G. Metaphorical Anti sickness medication Dopamine antagonists e. G. Aspirin, Metaphorical Serotonin agonies e. G. Arrogating and Tristan group of dugs (Samaritan, narration) agonies effects on serotonin 5-HTH B and 5-HTH D receptors in cranial blood vessels (causing their constriction) and subsequent inhibition of pro- inflammatory unreceptive release.
Side effects: Dizziness, drowsiness, sensory assistance including parenthesis and hypothesis, increase in blood pressure, dispense Describe the mechanism of action and main side effects of drugs used to prevent a migraine attack Prophylaxis (frequent attacks, more than 2 per month) Beta blockers e. G. Attention Not known Side effects: prognostications cannot be used in asthma, COOP patients. Cold hands and feet, tiredness and hallucinations Tricycle Antidepressant- immateriality tachycardia, dizziness, vision difficulties, nausea, constipation, dry mouth and weight changes. Anticonvulsant sodium palpitate Obtain a comprehensive headache history Explain the rationale behind the pharmacological and other strategies used to treat primary headaches For pain relief To dampen down the symptoms caused by the headaches.
Describe the relative frequency of dangerous and non-dangerous headaches To demonstrate the process of diagnostic reasoning in a patient as applied to individual presentations Take a pain history List the key features of dangerous headaches requiring urgent investigation and management for example meningitis and subtractions hemorrhage (SASH) Strike suddenly and cause severe pain. Are accompanied by vision changes, confusion, loss of consciousness, numbness, or any similar changes. 0 Wakes you up during the night. 0 Become more frequent or severe. 0 Follows a blow to the head. 0 Occur with fever or a stiff neck. 0 Occur in young children or older adults. 0 Repeatedly affect the same area such as an eye or ear. 0 Are accompanied by convulsions. Meningitis Severe headache Vomiting with malaise Fever Rigors Neck stiffness and Kerning’s sign (inability to allow full extension of knee when hip is flexed at 900) Subtractions hemorrhage
Symptomatic if ruptured or due to mass effect Painful third nerve palsy Sudden severe headache, often occipital Loss of consciousness (sometimes) Signs of mingle irritation (neck stiffness, Kerning’s sign) Describe the emergency investigation and management of a patient with suspected SASH Emergency investigations CT- first rush Lumbar puncture- if CT negative and non contraindication >rah after headache onset SF- bloody early on and becomes socioeconomic (yellow) due to blurring from breakdown of Hub. MR.. Angiography -to establish source of bleeding Emergency management Cerebral perfusion- keep well hydrated and aim for SSP>McHugh. Analgesia Impending- calcium antagonist that reduces passivism and consequent morbidity from cerebral chemical.