头痛病理培训课件.ppt

Hypertension Rare! Blood pressure must be sustained above 140 diastolic Can cause visual loss from severe papilledema with macular edema Pheochromocytoma, nephritis, malignant hypertension Pounding HA with nausea, tachycardia, sweating, pallor, and anxiety Sinus Acute; pain is almost always present Chronic; pain is almost always absent HA is frontal and can effect the malar area of the face, the teeth, and between or behind the eyes Congested feeling with nasal drainage, worsened by changing posture Treat with decongestants and OTC analgesics TMJ Temporal mandibular joint (TMJ) syndrome Pain in trigeminal and facial nerve areas Age 15-40 , FM 5% of population Originates from the jaw joint and is worse with chewing Jaw clicking or locking Manage with dental devices and analgesics Ophthalmodynia Sharp, stabbing, fleeting pain localized to one eye Probably occurs along CN V ophthalmic branch Often a history of migraines is present Benign Cause is unknown Ocular Causes of Headache Angle closure glaucoma Uveitis, keratitis, scleritis Optic neuritis Refractive disorders and muscle imbalance Metastatic orbital tumors Headache Work-up Review HISTORY, HISTORY, HISTORY! CN evaluation Neurological work up when indicated Blood pressure Refraction Binocular/accommodation testing Sinus evaluation Headache Work-up Review Complete ocular health assessment Visual field testing Correct referral is to a neurologist Consider brain scan if suspect brain tumor, hx of seizures, recent head trauma, significant changes in HA, abnormal neurological signs * Attack Aborting Treatment Cerebral Vasoconstrictive Agents: Ergotamine tartrate (Ergomar)- alpha adrenonergic antagonist--vasoconstrictor Dihydroergotoamine (Migranal, DHE45)- Theory is that it selectively binds to 5-HydroxyTryptamine (5HT) receptors on intracranial blood vessels which leads to their constriction OR the drug binds to 5HT receptors on the peripheral trigeminal nerve which results in blocking the inflammatory (pain) r