-IBIS-1.5.0-
tx
nervous system
headache: vascular
diagnoses
definition and etiology
definition: Headaches from vascular disturbance.
etiology: There are several types of vascular headaches:
migraine:
Periodic throbbing headaches. The prodrome seems to be due to a vasoconstriction of the cerebral blood vessels (or the vessels leading into the brain), while the headache itself seems to be due to a vasodilation of the blood vessels with subsequent congestion of tissues.
Seen more often in women and is thought to affect up to 20-30% of the population.
Usually begins between the ages of 10-30, and remissions commonly occur after age 50, suggesting a hormonal cause.
Definite familial component.
hypertension:
The headache is typically throbbing and located in the occiput or vertex. It is paroxysmal. There is a history of renal or cardiovascular disease.
cluster (histamine headaches):
Much more frequent in men.
Associated histaminic symptoms
miscellaneous: Toxic states; infections; alcoholism; uremia; lead; arsenic; morphine; carbon monoxide; poisoning; encephalitides:
Headache is moderate in intensity.
There is a history of exposure to a toxin, or other signs and symptoms that would point to a associated microorganism.
signs and symptoms
signs and symptoms:
migraine:
May be unilateral or bilateral: often located about or behind an eye spreading to one or both sides of the head.
Frequently there is nausea and vomiting, and a desire for darkness and quiet.
The headache lasts from hours to 1-3 days.
Classic type has a prodrome of various symptoms: scintillating scotomas, mood swings, dizziness and tinnitus, dazzling zigzags, perhaps feeling of impending doom.
Physical and neurological findings between attacks are unremarkable; during attacks there may be transient neurological signs.
lab findings: rule out organic disease
Skull x-ray.
Brain scan.
EEG.
hypertension: The headache is typically throbbing and located in the occiput or vertex. It is paroxysmal. There is a history of renal or cardiac disease (such as hypertension).
Physical exam will reveal hypertension, with retinopathy, edema and cardiac findings. Generally, the hypertensive headache is associated with advanced hypertensive disease or attacks of potentially serious hypertension.
lab findings:
Blood chemistries.
Renal studies.
cluster:
Headaches are paroxysmal.
Often wake the patient at night.
Abrupt onset of severe pain; lasts 1-2 hours.
occur typically in clusters of days to weeks and then are not experienced again for months or years.
Unilateral with associated histaminic symptoms: lacrimation, plugged nose, ptosis, cheek flushed and edemic.
Remissions may occur lasting for years or permanently.
physical exam:
Shows facial vasodilation; pupillary constriction; injected conjunctiva; tenderness to palpation of external and common carotid arteries.
miscellaneous:
There is a history of exposure to a toxin, or other signs and symptoms that would point to a associated microorganism.
lab findings:
Specific to the causative agent.
Lumbar puncture.
Blood and urine studies.
course and prognosis
In general, migraine and cluster headaches are chronic conditions that recur and are not cured by conventional treatment. Although they are both benign, the pains can be debilitating and cause much morbidity. Conventional treatment usually involves ergotamine prophylaxis and narcotic analgesics.
The hypertensive headache is correctable by controlling the patient's hypertension; if uncontrolled, then serious hypertensive sequelae may occur (e.g. stroke).
The toxic headache is treated by dealing with the toxic exposure and ridding the body of the substance.
Prognosis for migraine headache is favorable if thorough assessment and avoidance of triggers, along with biochemical/metabolic therapy is undertaken.
differential diagnosis
Nonvascular headache.
Brain tumor.
Hemangioma.
Carotid aneurysm.
Meniere's disease.
Seizure disease.
footnotes