Migraines and Headaches Overview

Migraine

• Common characteristics include unilateral pain in 70% of cases and bilateral or global in 30%.
• Quality is typically throbbing or aching, variable severity, with a rapid onset that peaks in 1 to 2 hours, lasting from 4 to 72 hours.
• Associated symptoms: nausea, vomiting, photophobia, phonophobia, visual auras, and sensory or motor effects.
• Provoking factors: alcohol, certain foods, tension, noise, bright light; relief from quiet, dark rooms, and sleep.

Cluster Headache

• Location usually unilateral, behind or around the eye, with deep, continuous, and severe pain.
• Abrupt onset that peaks within minutes, duration up to three hours.
• Associated symptoms: lacrimation, rhinorrhea, miosis, ptosis, eyelid edema.
• Increased sensitivity to alcohol during episodes.

Analgesic Rebound Headache

• Location follows previous headache patterns, quality and onset variable, duration depends on prior headache.
• Associated with conditions like fever, carbon monoxide exposure, hypoxia, and caffeine withdrawal.

Headaches from Eye Disorders

• Characterized by pain around and over the eyes, possibly radiating to the occipital area.
• Quality is steady, aching, and dull, duration is variable, usually lasting days.
• Symptoms may include nausea, vomiting, neck pain, increased intracranial pressure, and cerebral edema.

Brain Tumor Headache

• Location varies based on tumor position, quality is aching and steady, intensity is variable.
• Onset is often brief with increased symptoms upon coughing or rebleeding, and decreased by specialized treatment.

Giant Cell Arteritis

• Location near the affected artery, often the temporal or occipital region; age-related condition.
• Quality is throbbing, sometimes generalized; onset may be gradual or rapid with variable duration.
• Symptoms include scalp tenderness, fatigue, weight loss, and jaw claudication, exacerbated by neck and shoulder movement, improved with steroids.

Post-Concussion Headache

• Often localized to the injury site, characterized by generalized, dull, and constant pain.
• Onset within two hours to two days post-injury, duration can last weeks, months, or years.
• Associated symptoms: drowsiness, confusion, memory loss, blurred vision, increased with mental and physical exertion.

Glossopharyngeal Nerve (IX)

• Motor functions involve the pharynx; sensory functions include the posterior portions of the eardrum and pharynx.
• Weakness in palate or pharynx can impair swallowing; unilateral paralysis causes deviation of the uvula.

Vagus Nerve (X)

• Motor control of the palate, pharynx, and larynx; sensory function includes the pharynx and larynx.

Spinal Accessory Nerve (XI)

• Motor function includes sternocleidomastoid and upper trapezius muscles.
• Assessment involves muscle strength during shoulder shrug and head turn against resistance.

Hypoglossal Nerve (XII)

• Motor function is essential for tongue movements; dysarthria may occur from damage to cranial nerves X or XII.
• Deviated tongue points to weakness on the side of the lesion; atrophy and fasciculations visible in certain conditions.

Increased Intracranial Pressure

• Papilledema causes optic disc swelling due to axonal edema; signs include blurred margins and loss of venous pulsations.
• Symptoms of elevated pressure: headache, blurred vision, vomiting, behavioral changes, weakness, and lack of energy.

Cerebrovascular Accident (CVA)

• Stroke results from cerebral ischemia (87%) or hemorrhage (13%); subtypes include intracerebral (10%) and subarachnoid (3%).
• Warning signs include facial drooping, arm weakness, and speech difficulty; immediate emergency response is crucial.

Transient Ischemic Attack (TIA)

• Sudden focal brain dysfunction with recovery within 24 hours; significant stroke risk in the following months.
• Alerts: sudden numbness, confusion, trouble speaking, vision problems, and severe headache without known cause.

Examination Techniques in Children

• Early non-disturbing maneuvers, more distressing ones towards the end; engage infants with toys to facilitate the exam.
• For older children, follow adult exam sequences while examining painful areas last.

Apgar Score

• Assessment of newborns at 1 and 5 minutes post-birth using a three-point scale.
• Score of eight or higher leads to more comprehensive examination.

Cervical Myelopathy

• Neck pain often accompanied by bilateral weakness and paresthesia in both upper and lower extremities.
• Symptoms can include urinary frequency, hand clumsiness, palmar paresthesia, and subtle gait changes.
• Neck flexion typically exacerbates symptoms.
• Physical examination findings may include hyperreflexia, clonus at wrist and knee, positive Babinski sign, and gait disturbances.
• Lhermitte's sign indicates electrical shock sensations radiating down the spine upon neck flexion.
• Confirmation of cervical myelopathy requires neck immobilization and neurosurgical evaluation.

Neurological Examination Techniques

• Focus on determining lesion location in the nervous system and underlying pathophysiology.
• Central nervous system (CNS) versus peripheral nervous system (PNS) distinction is crucial.
• Special techniques include looking for meningeal signs, ensuring no cervical vertebral injury or cord fracture, often necessitating radiologic evaluation.
• Brudzinski's sign is assessed during examination.

CNS Anatomy

• Brain regions include the cerebrum, diencephalon, brainstem, and cerebellum.
• Each cerebral hemisphere comprises frontal, parietal, temporal, and occipital lobes.
• The brain contains gray matter and myelinated neuronal axons (white matter).
• Key structures within the brain include basal ganglia, thalamus, hypothalamus, reticular activating system, and cerebellum.

Spinal Cord Function

• Spinal cord extends from medulla to first or second lumbar vertebrae.
• Organized into five segments: cervical (C1-C8), thoracic (T1-T12), lumbar (L1-L5), sacral (S1-S5), and coccygeal.
• Contains crucial motor and sensory nerve pathways that connect to spinal and peripheral nerves.
• Mediates monosynaptic muscle stretch reflexes.

Peripheral Nervous System Overview

• Comprises 12 pairs of cranial nerves and spinal/peripheral nerves containing both motor and sensory fibers.
• Cranial nerves emerge through skull foramina and canals to supply structures in the head and neck.

Syncope

• Defined as temporary loss of consciousness due to decreased cerebral blood flow.
• Document detailed descriptions of the event, including setting, triggers, warning signs, duration, and recovery details.
• Young individuals may experience vasopressor syncope associated with emotional stress.
• Differential diagnosis includes seizures and neurocardiogenic conditions like vasovagal syncope, postural tachycardia syndrome, and arrhythmias.

Headaches

• Tension Headache: Characterized by pressing or tightening pain, often mild to moderate intensity. Gradual onset; duration varies from minutes to days. Commonly associated with muscle tension.
• Brain Tumor Headache: Location varies; typically aching, steady, may worsen with coughing or increase in intracranial pressure.
• Giant Cell Arteritis: Throbbing pain often near involved arteries, particularly temporal and occipital areas. Associated with tenderness, fever, fatigue, and jaw claudication.
• Postconcussion Headache: Generalized, dull pain developing within hours to days of injury, lasting for weeks or longer. Symptoms include confusion, memory loss, and increased with exertion.

Cranial Nerves

• IX - Glossopharyngeal: Responsible for motor function in the pharynx, and sensory function in the eardrum, ear canal, pharynx, and posterior tongue. Impairments may include swallowing difficulties and hoarseness.
• X - Vagus: Similar functions in the pharynx and larynx.
• XI - Spinal Accessory: Motor function for sternocleidomastoid and upper trapezius. Examination involves assessing muscle bulk and strength, particularly in shoulder shrug.
• XII - Hypoglossal: Controls tongue movement. Examination focuses on articulation and tongue symmetry, with signs of weakness including deviation towards the weak side.