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17 Cards in this Set
- Front
- Back
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What cranial structures are sensitive to pain? Insensitive?
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Insensitive: brain tissue
Sensitive: venous sinuses, dural arteries, Circle of Willis, Trigeminal fibers, CN IX, X, dura at base of skull, upper cervical nerves |
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What neurotransmitter pathways are involved in the generation of pain?
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5HT, Epi (adrinergic)
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Describe the two pain systems and the interneurons both utilize.
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Ascending 5HT system: midbrain raphe-->blood vessels-->hthal, thal, cortex
Descendind modulation: PAG midbrain-->dorsal horn SC (NE: locus coeruleus-->sc, cortex) Inhibitory interneurons w/Substance P (5-HT) or GABA (NE) |
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What does the trigeminovascular hypothesis state?
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1) Trigeminal fibers innervate BV's in meninges, extracranial aa, circle of Willis
2) Nerve endings contain NT's that trigger release of neuropeps (Substance P, CGRP) which promote release of plasma prots and fluid from meningeal BV's CGRP acts as vasodilator (inflammatory response aroudn innervated BV's) 3) Trigeminal nerve secondarily act'd by these vents, transmits pain impulses to trigeminal nuc, and then to higher centers |
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Primary and Secondary Headaches
Examples |
Primary (unassoc'd w/structural lzn): Migraine, tension headache, cluster headache
Secondary: increased intracranial pressure, infections/inflammn, structural lzns, drugs/toxins |
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What are dangerous headache signs?
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NEW headaches occuring in individual who doesn't usually suffer from this syx
Sudden onset of SEVERE headache Change in pattern of HA HA assocd w/persistent focal neuro syx HA assocd w/signs of intracranital HTN HA assocd w/fever, stiff neck, confusion, sleepiness |
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Symptoms of migraine
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HA is pulsating, throbbing; nausea, vomiting, photophobia, incapacatiation until sleep ends attack
(longer the attack, lower probability that it's a migrain) (COMMON IN SMALL CHILDREN) |
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Classic Migraine
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with aura: preceded/accompanied by focal neuro syx (usually positive visual phenomena)
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Common Migraine
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without aura
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Complex Migraine
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Runs in families, includes periodic attack of opthalmoplegia, hemiplegia, confusion, ataxia (ALL REVERSIBLE)
MUST be distinguished from TIA/stroke (NEED NOT be accompanied by head pain or usual signs of migraines) |
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Tension Headache
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Generalized discomfort, no significant nausea, photophobia, limitation of function
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Cluster Headache
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Unliateral and supra-, retro-orbital or temporal
Relatively short Usually have predictable assocn with EtOH or smoking; assocd with ptosis, meiosis, tearing, nasal congestion Men>>women |
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Why is it that only 1-3% of patients with brain tumors present with a headache alone?
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Interference with a pain-sensitive structure has to occur or a sufficient size needs to be attained to increase intracranial pressure.
Masses adjacent to meninges, in posterior fossa, and at skull base more likely to present with headache, nausea, and vomiting. |
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How does headache etiology differ in the elderly?
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Secondary causes more common in elderly
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Temporal Arteritis:
AKA Affected Populations Description Symptoms Treatment |
Almost exclusive to elderly
AKA Giant Cell Arteritis Emergency! Permanent loss of vision in 25% pts sans tx Autoimmune disorder causing systemic, necrotizing granulomatous inflammation of medium-sized aa (visual loss secondary to ischemia of retina or optive nerve or both from inflammn) Syx: steady ache or dull throbbing in temples; stiff, painful proximal mm esp in AM (definitive dx via temporal artery bx) Tx: Predisone STAT and for several mos; if bx neg, discontinue--long-term use in elderly causes gastric comlpication, hyperglycemia, osteoporosis, so need to be monitored. |
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Subdural Hematoma:
Affected populations Symptoms Treatment |
Occurs more frequently in older adults
Often due to stretching of bridging vv. Cna develop after minor head trauma, vigorous sneezing Syx: dull, mild and generalized HA assocd w/drowsiness, confusion, personality changes Tx: most resolve sans sx |
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Trigeminal Neuralgia:
Affected populations Affected nerves Cause Symptoms |
Age-associated: 90% of cases over age 40
Maxillary and Mandibular most affected Cause: compression of CN V root by artery in posterior fossa; previous viral infection is a risk (Herpes) Syx: unilateral, sharp, jabbing head pain occuring in a repetitive, crecendo, wave-like pattern lasting a few secs. Unlike cluster, pain triggered by TOUCHING or STIMULATING FACE (shaving, chewing, laughign, brushing teeth) Pain is excruciating and pts can be disabled by both pain and fear of pain |
