headache.pptx neurology brain disorderss

brain and neuro disorders

1. HEADACHE Praveen kummar

2. INTRODUCTION Most common of all human physical complaints Despite regional variations, headache disorders are a worldwide problem, affecting people of all ages, races, income levels, & geographical area Headache is a painful and disabling feature , and are the most common disorder of the nervous system.

3. Definition A headache is a pain or discomfort in the head, scalp, or neck. The major types are Primary Headache Secondary Headache

4. Primary Headache A primary headache is due to the headache condition itself and not due to another cause. Types of primary headache are Migraine Tension Type Cluster Other types

5. MIGRAINE HEADACHE Considered as vascular headache Migraine headache is a recurring pain characterized by unilateral or bilateral throbbing Pain . Migraine type of headache occurs more in females then males It is associated with anatomical or nervous system dysfunction

6. Types Common migraine: it has no "aura.” About 80% of migraines are common. Classic migraines (migraine with aura ): it present with an aura before the headache and are more severe than common migraines. A silent or acephalgic migraine: it is a migraine without head pain but with aura and other aspects of migraine. A hemiplegic migraine: This can have symptoms that mimic a stroke, such as weakness on one side of the body, loss of sensation, or feeling "pins and needles." A retinal migraine: Retinal migraine causes temporary vision loss in one eye, which can last from minutes to months, but it is usually reversible. This is often a sign of a more serious medical problem, and patients should seek medical care. A chronic migraine: It is a migraine headache that lasts for more than 15 days per month for three consecutive months. Status migrainosus : it is a constant migraine attack that lasts more than 72 hours.

7. Etiology Hormonal changes in women.   Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause Hormonal medications, such as oral contraceptives and hormone replacement therapy Drinks.  These include alcohol, especially wine, and too much caffeine, such as coffee. Stress .  Stress at work or home can cause migraines. Sensory stimuli.   Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke Sleep changes.  Missing sleep, getting too much sleep Physical factors.  Intense physical exertion, including sexual activity, might provoke migraines. Weather changes.   Barometric pressure can prompt a migraine. Medications.  Oral contraceptives and vasodilators, such as nitroglycerin . Foods.  Aged cheeses and salty and processed foods, skipping meals or fasting. Food additives.   Sweetener aspartame and the preservative monosodium glutamate (MSG )

8. Pathophysiology Presymptomatic hyperexcitabilty increases brain stem response to triggers Release of Neurotransmitters (5-HT, NE, DA, GABA, Glutamate, NO, CGRP, Substance P, Estrogen ) Neurotransmitters activate the Trigeminal Nucleus Activation of Hypothalamus (Hypersensitivity) Activation of Area Postrema Activation of cervical trigeminal system (Muscle spasm ) Dilation of Meningeal blood vessels (Throbbing) Activation of Cortex and Thalamus (Head pain)

9. CLINICAL FEATURES Clinical manifestations of migraine headache are triggered by missing meal, intense stress, thymine rich food and sleep alteration Anorexia, Nausea, vomiting, Visual disturbances

10. Management Vasoconstrictor – sumatriptan Triptan nasal spray in pt with nauseaa and vomiting. Nursing care Should not given in hypertension , ischemic heart diseases Excesss dose can cause tremor

11. TENSION HEADACHE : Is the most common type of headache, is characterized by bilateral location. It is usually mild or moderate intensity and not aggravated by physical activity. Tension type headache is sub categorize as Infrequent episodic Frequent episodic Chronic

12. ETIOLOGY It caused due to sustained pain full contraction of the muscles of the scalps and neck Physical or emotional stress Alcohol use Caffeine (too much or withdrawal) Colds, the flu, or a sinus infection Dental problems such as jaw clenching or teeth grinding Eye strain Excessive smoking Fatigue or overexertion

13. Clinical manifestation The headache pain may be described as: Dull, pressure-like (not throbbing) A tight band or vise on or around the head All over (not just in one point or one side) Worse in the scalp, temples, or back of the neck, and possibly in the shoulders The pain may occur once, constantly, or daily. Pain may last for 30 minutes to 7 days. It may be triggered by or get worse with stress, fatigue, noise, or glare. There may be difficulty sleeping. People with tension headaches try to relieve pain by massaging their scalp, temples, or the bottom of the neck. Sleep disturbances Photophobia – sensitivity to light Phonophobia – sensitivity to sound

14. Management Over-the-counter (OTC) pain medicines, such as aspirin, ibuprofen, or acetaminophen Narcotic pain relievers are generally not recommended Muscle relaxers Tricyclic antidepressants to prevent recurrences

15. Health Education Keep warm if the headache is associated with cold. Use a different pillow or change sleeping positions. Practice good posture when reading, working, or doing other activities. Exercise the neck and shoulders frequently when working on computers or doing other close work. Get plenty of sleep and rest. 

16. Secondary Headache A secondary headache is present because of another condition. The management of secondary headache focuses on diagnosis and treatment of the underlying condition. The types of secondary headache are Systemic infection E.g. Meningitis, Head injury Vascular disorders E.g. Aneurysm Rupture, Stroke Subarachnoid hemorrhage Brain tumor

17. CLUSTER HEADACHE: A cluster headache commonly awakens you in the middle of the night with intense pain in or around one eye on one side of your head. Bouts of frequent attacks, known as cluster periods, can last from weeks to months, usually followed by remission periods when the headaches stop

18. Types There are two types of cluster headaches: episodic and chronic. Episodic cluster headaches occur regularly between one week and one year, followed by a headache-free period of one month or more. Chronic cluster headaches occur regularly for longer than one year, followed by a headache free period that lasts for less than one month.

19. Etiology Exact cause is unknown Sudden release of histamine, serotonin  Hypothalamic issues Others Alcohol and cigarette smoking High altitudes (trekking and air travel) Bright light (including sunlight) Exertion (physical activity) Heat (hot weather or hot baths) Foods high in nitrites (bacon and preserved meats) Certain medicines Cocaine

20. Clinical manifestation Excruciating pain that is generally situated in, behind or around one eye, but may radiate to other areas of face , head and neck One-sided pain Restlessness Excessive tearing Redness of your eye on the affected side Stuffy or runny nose on the affected side Forehead or facial sweating on the affected side Pale skin (pallor) or flushing on your face Swelling around your eye on the affected side Drooping eyelid on the affected side

21. Medication Pain medication relieves your headache pain once it has begun. Treatments include: Oxygen: Breathing 100-percent pure oxygen when the headache begins can help relieve symptoms. Triptan medications: A nasal spray medication called sumatriptan ( Imitrex ), or other tripitan medications constrict blood vessels, which can help ease your headache. DHE: An injected medication called dihydroergotamine (DHE), can often relieve cluster headache pain within five minutes of use. Note: DHE can’t be taken with sumatriptan . Capsaicin cream: Topical capsaicin cream can be applied to the painful area.

22. Blood pressure medications, such as propranolol or verapamil which relax your blood vessels Steroid medications, such as prednisone, which reduce nerve inflammation A medication called ergotamine that keeps your blood vessels from dilating Antidepressant medications Anti-seizure medications, such as topiramate and valproic acid Lithium carbonate Muscle relaxants, such as baclofen

23. Surgery As a last resort, a surgical procedure can be used to disable the trigeminal nerve. 

24. Risk factors Sex .  Men are more likely to have cluster headaches. Age.  Most people who develop cluster headaches are between ages 20 and 50, although the condition can develop at any age. Smoking.  Many people who get cluster headache attacks are smokers. However, quitting smoking usually has no effect on the headaches. Alcohol use.  If you have cluster headaches, drinking alcohol during a cluster period may increase your risk of an attack. A family history.  Having a parent or sibling who has had cluster headache might increase your risk.

25. LUMBAR PUNCTURE HEADACHE Headache after Lumbar puncture. Occurs within 48 hrs but delayed up to 12 hrs. Begins when the client sits or stand upright . Reduction with abdominal compression, worsened with headshaking.

26. DIAGNOSTIC TESTS : History taking Physical examination Electromyography ( EMG ) = this test may reveals the sustained contractions of the muscles of the neck , face & scalp

27. Nursing management Help to identify the stressful stimuli and learn to cope with that. Daily exercise, relaxation and socialization. Encourage to avoid beverages Massage and moist heat on head to reduce tension headache . Patient should avoid smoking Provide quite dim light Comfort measures and stress reduction technique.

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