STUDY - Technical - New Dacian's Medicine
Headaches
(1)
Translation Draft
Headache may be based on any of the mechanisms of pain. The following cranial structures are sensitive to mechanical stimulation: scalp and aponevrotics, medium meningeal artery, dural sinuses, brain scythe and proximal segments of large pial arteries.
Ventricular ependimus, choroid plexus, pial veins and much of the brain parenchyma are insensitive to pain. Electrical stimulation of cells near the dorsal raffle of the mesencephalus causes migraine-like headaches.
Thus, most of the brain is insensitive to electrostimulation, but a certain area of the mesencephalus may be a possible source of the headache. Sensory stimuli in the head are transmitted by the central nervous system via the trigeminal nerves for structures above the tentorium. The ninth and tenth cranial nerves irritate part of the posterior fossa and radiate pain in the ears and neck.
So, headache may occur as a result of: 1. distension, traction or dilation of the cranial or extracranial arteries, 2. traction or displacement of large intracranial veins or their dural shell, 3. compression, traction or inflammation of the cranial or spinal nerves, 4. spasm, inflammation and trauma of the cranial and cervical muscles, 5. meningeal irritation and increased intracranial pressure and 6. possible, disruption of intracerebral serotonin projections.
Depending on how bulky they are, intracranial masses can cause headaches when deforming, moving or exerting traction of vessels, dural structures or cranial nerves at the base of the brain (this often happens long before increased intracranial pressure).
Such displacement mechanisms do not explain headaches resulting from cerebral ischemia or benign intracranial hypertension after the pressure is reduced, or frequent headaches in febrile diseases or systemic lupus erythematosus. Disruption of intracerebral serotonin projections has been suggested as a possible mechanism for these phenomena.
Severe, disabling headache is reported at least annually in 40% of individuals worldwide. In some individuals, stress and anxiety can trigger "benign" headache, but emotional factors are not necessary for the syndrome to occur.
The more severe the headache, the more likely it is to be associated with nausea and to be felt as pulsating and annoying discomfort, with hyperacusis and photophobia often present. Headache is usually a benign symptom and only occasionally is the manifestation of a severe disease, such as brain tumor, subarachnoid hemorrhage, meningitis or giant cell arteritis. Even in emergency situations, only 5% of patients with headache are found to have severe neurological disease.
Most headaches are deaf, deeply localized and have a continuous character. Superimposed on such blurred pain there may be elements of other types of pain, which have higher diagnostic values, being useful to identify by the patient all types of pain that are experienced by him, independent of their frequency and intensity.
The feeling of pulsatility and muscle tension in the head, neck and scapular belt accompany nonspecific and frequent headache. it is believed that "band" headaches indicate stress, anxiety or depreciation. Sharp, deaf headache, like a puncture, often multifocal, is the certainty of a benign disorder. Pain intensity rarely has diagnostic value, at the head or in any other somatic localization, with people responding to pain in a variety of ways, from open theatrical behavior to stoicism.
And patients with severe headaches usually have migraines. Meningitis, subarachnoid hemorrhage and localized headache (cluster) also produce intense cranial pain. Contrary to common ideas, the pain caused by a brain tumor is not usually particularly distinctive or severe.
The location of the headache can provide useful information. if the source is an extracranial structure, as in giant cell arteritis, the correspondence with the place of pain is relatively accurate. Inflammation of an extracranial artery causes pain and sharp tenderness, localized in the vessel. Injuries to the prenasal sinuses, teeth, eyes and upper cervical vertebrae induce a less accurate localization pain, but which usually constantly irradiates in the same territory. Intracranial lesions in the upper fossa produce pain that is usually occipithonucal, and supratentorial lesions most often induce frontotemporal pain.
The lasting and intensity-time curves of headache are in some cases useful. a ruptured aneurysm results in a headache that reaches its peak instantly, like a lightning bolt, and less often, aneurysms that have not ruptured can signal your presence in the same way.
Localized headache attacks peak in about 3 to 5 minutes, remain at the peak of around 45 minutes and then diminish. Migraine pain intensifies over the course of hours, is maintained for several hours or days and is characteristically improved by sleep. Sleep disturbance is characteristic of headaches caused by brain tumors.
Recurrent headache may be related to certain biological events or changes in the physical environment. The following phenomena of exacerbation most likely confer a benign etiology to the syndrome: red wine challenge, sustained effort, organic smells, hunger, lack of sleep, weather changes and menstruation.
The association of bouts with diarrhea and its relief during pregnancy, especially in the second and third trimesters are pathognomonic for migraine. Patients with continuous benign headache often notice a painless interlude of several minutes upon awakening before the headache recurs.
This phenomenon occurs along with other painful syndromes, such as talamic pain, but does not occur when the cause of pain is inflammation (meningitis or giant cell arteritis). Activation of the mechanism by drinking red wine or by starvation, for example, is inconsistent, for reasons that are unclear.
An anamnesis with amenorrhea or galactorea must raise the question of whether polycystic ovary syndrome or a pituitary adenoma that secretes prolactin is the source of pain. Novo headache in a patient with known malignancies suggests either brain metastases or/ and carcinomatous meningitis. When there is a striking increase in pain with eye movements, a systemic infection and especially meningitis should be seriously considered.
Headache that occurs suddenly after bending, lifting or coughing may highlight the existence of a tumor mass in the posterior fossa or Arnold-Chiari malformation. Orthostatic headache occurs after lumbar puncture and also when there is a subdural hematoma or benign intracranial hypertension.
The eye itself is rarely the cause of acute orbital pain, if the sclerosis are white and are not injected, a "red eye" being the sign of an ophthalmological disease. In optic neuritis, pain is typically localized to the eye or supraorbital region and is exacerbated by eye movements.
Similarly, acute sinusitis can almost always be diagnosed by a purulent, dark green nasal exudate. Then, glosopharyngeal neuralgia, and especially trigeminal neuralgia, are common causes of facial pain. "Neuralgias" are painful disorders characterized by paroxysmal, transient episodes, similar to electric shocks, which are caused by demyelinating lesions of the nerves (the trigeminal or glossopharynx nerve in the cranial neuralgias). Certain maneuvers characteristically trigger the paroxysm of pain.
However, the most common cause of facial pain is by far dental pain, the challenge through hot, cold or sweet foods being typical. The application of a cold stimulus will repeatedly cause dental pain, as long as in neuralgic changes, after the initial response usually occurs a refractory period, so that the pain cannot be induced repeatedly. The presence of refractory periods can almost always be highlighted in anamnesis, so there is no need for patients to go through a painful experience.
The effect of food intake on facial pain may provide data on the cause. Chewing, swallowing or taste of food triggers pain (chewing clearly highlights trigeminal neuralgia, dysfunction of the temporomandibular joint or giant cell arteritis, claudication of the jaw, while triggering by swallowing and taste highlights glosopharyngeal neuralgia, pain during swallowing is common in patients with carotid, because the inflamed and sensitive carotid artery borders the esophagus during swallowing).
Many patients who accuse facial pain do not describe stereotypical neuralgia, in these situations the expression "atypical facial pain" is used. Continuous, poorly located and vague facial pain is characteristic of nasopharyngeal carcinoma. A burning pain occurs during decommissioning and the appearance of evidence of cranial neuropathy.
Facial pain as a burn may also occur during decommissioning and evidence of cranial neuropathy. It can also occur in tumors of the cranial nerve V (meningioma or schwannom) or in bridge lesions that interrupt the entrance area of the posterior root of the nerve (multiple sclerosis).
Let's now proceed to the description of the different types of headache, starting with migraine, by far the most common cause of headache. A practical definition of migraine is that of a benign and recurrent syndrome with headache, nausea, vomiting and/ or other symptoms of neurological dysfunction in different associations. Migraine can often be recognized by its triggers (red wine, menstruation, hunger, sleep deprivation, bright light, estrogens, concern, perfumes, periods of depression) and factors that eliminate it (sleep, pregnancy, joy, medication).
Localized headache (cluster) is a syndrome that has the most common form of manifestation through 1 to 3 short attacks of periorbital pain, daily, over an interval of 4 to 8 weeks, followed by pain-free intervals of up to one year. Painful attacks are commonly associated with homeolateral redness of the eye, tear, ptosis and nasal obstruction.
Tension headache is a term commonly used to describe a chronic headache syndrome, characterized by discomfort similar to the strong tightening of a bandage, with patients describing that they feel as if the head is trapped in a vise or have tense posterior neck muscles.
Pain typically appears slow, fluctuates in severity and may persist more or less continuously for several days. In some patients anxiety or depression coexists with tension headache. Many studies claim that periodic tension headache is not biologically distinguishable from migraine.
We'll continue tomorrow with the headache...
Headache may be based on any of the mechanisms of pain. The following cranial structures are sensitive to mechanical stimulation: scalp and aponevrotics, medium meningeal artery, dural sinuses, brain scythe and proximal segments of large pial arteries.
Ventricular ependimus, choroid plexus, pial veins and much of the brain parenchyma are insensitive to pain. Electrical stimulation of cells near the dorsal raffle of the mesencephalus causes migraine-like headaches.
Thus, most of the brain is insensitive to electrostimulation, but a certain area of the mesencephalus may be a possible source of the headache. Sensory stimuli in the head are transmitted by the central nervous system via the trigeminal nerves for structures above the tentorium. The ninth and tenth cranial nerves irritate part of the posterior fossa and radiate pain in the ears and neck.
So, headache may occur as a result of: 1. distension, traction or dilation of the cranial or extracranial arteries, 2. traction or displacement of large intracranial veins or their dural shell, 3. compression, traction or inflammation of the cranial or spinal nerves, 4. spasm, inflammation and trauma of the cranial and cervical muscles, 5. meningeal irritation and increased intracranial pressure and 6. possible, disruption of intracerebral serotonin projections.
Depending on how bulky they are, intracranial masses can cause headaches when deforming, moving or exerting traction of vessels, dural structures or cranial nerves at the base of the brain (this often happens long before increased intracranial pressure).
Such displacement mechanisms do not explain headaches resulting from cerebral ischemia or benign intracranial hypertension after the pressure is reduced, or frequent headaches in febrile diseases or systemic lupus erythematosus. Disruption of intracerebral serotonin projections has been suggested as a possible mechanism for these phenomena.
Severe, disabling headache is reported at least annually in 40% of individuals worldwide. In some individuals, stress and anxiety can trigger "benign" headache, but emotional factors are not necessary for the syndrome to occur.
The more severe the headache, the more likely it is to be associated with nausea and to be felt as pulsating and annoying discomfort, with hyperacusis and photophobia often present. Headache is usually a benign symptom and only occasionally is the manifestation of a severe disease, such as brain tumor, subarachnoid hemorrhage, meningitis or giant cell arteritis. Even in emergency situations, only 5% of patients with headache are found to have severe neurological disease.
Most headaches are deaf, deeply localized and have a continuous character. Superimposed on such blurred pain there may be elements of other types of pain, which have higher diagnostic values, being useful to identify by the patient all types of pain that are experienced by him, independent of their frequency and intensity.
The feeling of pulsatility and muscle tension in the head, neck and scapular belt accompany nonspecific and frequent headache. it is believed that "band" headaches indicate stress, anxiety or depreciation. Sharp, deaf headache, like a puncture, often multifocal, is the certainty of a benign disorder. Pain intensity rarely has diagnostic value, at the head or in any other somatic localization, with people responding to pain in a variety of ways, from open theatrical behavior to stoicism.
And patients with severe headaches usually have migraines. Meningitis, subarachnoid hemorrhage and localized headache (cluster) also produce intense cranial pain. Contrary to common ideas, the pain caused by a brain tumor is not usually particularly distinctive or severe.
The location of the headache can provide useful information. if the source is an extracranial structure, as in giant cell arteritis, the correspondence with the place of pain is relatively accurate. Inflammation of an extracranial artery causes pain and sharp tenderness, localized in the vessel. Injuries to the prenasal sinuses, teeth, eyes and upper cervical vertebrae induce a less accurate localization pain, but which usually constantly irradiates in the same territory. Intracranial lesions in the upper fossa produce pain that is usually occipithonucal, and supratentorial lesions most often induce frontotemporal pain.
The lasting and intensity-time curves of headache are in some cases useful. a ruptured aneurysm results in a headache that reaches its peak instantly, like a lightning bolt, and less often, aneurysms that have not ruptured can signal your presence in the same way.
Localized headache attacks peak in about 3 to 5 minutes, remain at the peak of around 45 minutes and then diminish. Migraine pain intensifies over the course of hours, is maintained for several hours or days and is characteristically improved by sleep. Sleep disturbance is characteristic of headaches caused by brain tumors.
Recurrent headache may be related to certain biological events or changes in the physical environment. The following phenomena of exacerbation most likely confer a benign etiology to the syndrome: red wine challenge, sustained effort, organic smells, hunger, lack of sleep, weather changes and menstruation.
The association of bouts with diarrhea and its relief during pregnancy, especially in the second and third trimesters are pathognomonic for migraine. Patients with continuous benign headache often notice a painless interlude of several minutes upon awakening before the headache recurs.
This phenomenon occurs along with other painful syndromes, such as talamic pain, but does not occur when the cause of pain is inflammation (meningitis or giant cell arteritis). Activation of the mechanism by drinking red wine or by starvation, for example, is inconsistent, for reasons that are unclear.
An anamnesis with amenorrhea or galactorea must raise the question of whether polycystic ovary syndrome or a pituitary adenoma that secretes prolactin is the source of pain. Novo headache in a patient with known malignancies suggests either brain metastases or/ and carcinomatous meningitis. When there is a striking increase in pain with eye movements, a systemic infection and especially meningitis should be seriously considered.
Headache that occurs suddenly after bending, lifting or coughing may highlight the existence of a tumor mass in the posterior fossa or Arnold-Chiari malformation. Orthostatic headache occurs after lumbar puncture and also when there is a subdural hematoma or benign intracranial hypertension.
The eye itself is rarely the cause of acute orbital pain, if the sclerosis are white and are not injected, a "red eye" being the sign of an ophthalmological disease. In optic neuritis, pain is typically localized to the eye or supraorbital region and is exacerbated by eye movements.
Similarly, acute sinusitis can almost always be diagnosed by a purulent, dark green nasal exudate. Then, glosopharyngeal neuralgia, and especially trigeminal neuralgia, are common causes of facial pain. "Neuralgias" are painful disorders characterized by paroxysmal, transient episodes, similar to electric shocks, which are caused by demyelinating lesions of the nerves (the trigeminal or glossopharynx nerve in the cranial neuralgias). Certain maneuvers characteristically trigger the paroxysm of pain.
However, the most common cause of facial pain is by far dental pain, the challenge through hot, cold or sweet foods being typical. The application of a cold stimulus will repeatedly cause dental pain, as long as in neuralgic changes, after the initial response usually occurs a refractory period, so that the pain cannot be induced repeatedly. The presence of refractory periods can almost always be highlighted in anamnesis, so there is no need for patients to go through a painful experience.
The effect of food intake on facial pain may provide data on the cause. Chewing, swallowing or taste of food triggers pain (chewing clearly highlights trigeminal neuralgia, dysfunction of the temporomandibular joint or giant cell arteritis, claudication of the jaw, while triggering by swallowing and taste highlights glosopharyngeal neuralgia, pain during swallowing is common in patients with carotid, because the inflamed and sensitive carotid artery borders the esophagus during swallowing).
Many patients who accuse facial pain do not describe stereotypical neuralgia, in these situations the expression "atypical facial pain" is used. Continuous, poorly located and vague facial pain is characteristic of nasopharyngeal carcinoma. A burning pain occurs during decommissioning and the appearance of evidence of cranial neuropathy.
Facial pain as a burn may also occur during decommissioning and evidence of cranial neuropathy. It can also occur in tumors of the cranial nerve V (meningioma or schwannom) or in bridge lesions that interrupt the entrance area of the posterior root of the nerve (multiple sclerosis).
Let's now proceed to the description of the different types of headache, starting with migraine, by far the most common cause of headache. A practical definition of migraine is that of a benign and recurrent syndrome with headache, nausea, vomiting and/ or other symptoms of neurological dysfunction in different associations. Migraine can often be recognized by its triggers (red wine, menstruation, hunger, sleep deprivation, bright light, estrogens, concern, perfumes, periods of depression) and factors that eliminate it (sleep, pregnancy, joy, medication).
Localized headache (cluster) is a syndrome that has the most common form of manifestation through 1 to 3 short attacks of periorbital pain, daily, over an interval of 4 to 8 weeks, followed by pain-free intervals of up to one year. Painful attacks are commonly associated with homeolateral redness of the eye, tear, ptosis and nasal obstruction.
Tension headache is a term commonly used to describe a chronic headache syndrome, characterized by discomfort similar to the strong tightening of a bandage, with patients describing that they feel as if the head is trapped in a vise or have tense posterior neck muscles.
Pain typically appears slow, fluctuates in severity and may persist more or less continuously for several days. In some patients anxiety or depression coexists with tension headache. Many studies claim that periodic tension headache is not biologically distinguishable from migraine.
We'll continue tomorrow with the headache...
A
fruitful, successful week!
Dorin, Merticaru