THE MENINGESBoth the spinal cord and brain arecovered in three continuous sheets ofconnective tissue, the Meninges.From outside in, these arethe Dura materthe Arachnoidthe Pia materThe region between the Arachnoidand Pia mater is filled withcerebrospinal fluid (CSF).
White Matter vs. GrayMatterBoth the spinal cord and thebrain consist of whitematter = bundles of axonseach coated with a sheath ofmyelin gray matter =masses of the cell bodies anddendrites — each covered withsynapses.In the spinal cord, thewhite matter is at the surface,the gray matter inside.In the brain of mammals, thispattern is reversed.
The Spinal Cord31 pairs of spinal nerves arise along the spinal cord.These are "mixed" nerves because each contain bothsensory and motor axons.The spinal cord carries outtwo main functions:•It connects a large part of the peripheral nervoussystem to the brain. Information (nerve impulses)reaching the spinal cord through sensory neurons aretransmitted up into the brain. Signals arising in the motorareas of the brain travel back down the cord and leave inthe motor neurons.•The spinal cord also acts as a minor coordinating center
DIAGNOSTIC STUDIES OF NERVOUSSYSTEM
SKULL X RAYS
SPINE X RAYS
CEREBROSPINAL FLUID(CSF) ANALYSIS
CT = X-ray ComputedTomographyThis is an imaging techniquethat uses a series of X-rayexposures taken fromdifferent angles. Computersoftware can integrate theseto produce a three-dimensional picture of thebrain (or other body region).CT scanning is routinely usedto quickly diagnose strokes
MRI = MagneticResonance ImagingThis imaging techniqueuses powerful magnets todetect magneticmolecules within thebody. These can beendogenous molecules ormagnetic substancesinjected into a vein
TheElectroencephalograph(EEG)This device measureselectrical activity (brain"waves") that can bedetected at the surfaceof the scalp. It candistinguish between, forexample, sleep andexcitement. It is alsouseful in diagnosingbrain disorders such as atendency to epilepticseizures
HEADACHE IS PROBABLY THE MOSTCOMMON TYPE OF PAIN EXPERIENCED BYHUMANSHEADACHE IS A COMMON SYMPTOM OF MANY NEUROLOGIC CONDITIONS AND IS ALSO A SEPERATE DISEASE PROCESSA headache or cephalasia is the pain anywhere in the region of the head or neck, pericranial muscles,eyes and jaw
CAUSES OR ETIOLOGY
Types of headachesThere are three major categories of headaches:primary headaches,secondary headaches, andcranial neuralgias, facial pain, and other headaches
What are primary headaches?Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.Some primary headaches can be triggered by lifestyle factors, including:Alcohol, particularly red wineCertain foods, such as processed meats that contain nitratesChanges in sleep or lack of sleepPoor postureSkipped mealsStress
Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men.
Migrane headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime
Cluster headaches are a rare type of primary headache affecting 0.1% of the population (1 in a 1,000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headache.
What are secondary headaches?Secondary headaches are thosethat are due to an underlyingstructural problem in the head orneck. There are due to numerouscauses such as bleeding in thebrain, tumor, or meningitis
Others causesFeverCarbon monoxide exposureChronic lung diseasesHypothyroidismBirth control pills
Risk factorsFamily historyPrecipitating factors in headache includes Substances containing amines Ripened cheeses Yeast extractsChocolateRed wineAlchocolMenstrual period
pathophysiologyextra cranial blood vessels dilates these vascular changes may be secondary to neuronal discharges in the affected area of pain results in abnormal neuronal activities in brain due to abnormality in hypothalamus chemo receptors become dysfunctional
Clinical manifestations Migrane =atleast 5 attacks to two attacksTension type headache=duration30 minsTo 7 daysCluster headache=duration 15 to180 minutes if not treated
Other associated sympyomswith headacheRhinorrheaLacrimationNasal congestionEye lid edema
DiagnosticsObtain complete headache historyObtain complete medical historyPhysical assesment for checking muscle tightness and tendernessCt scanMRIXrays
Clinical managementProvide symptomatic relief of headacheCheck the following baseline investigationsNON PHARMACOLOGICAL1. AVOID THE PRECIPITATING FACTORS2. ELIMINATE UNNECCESARY MEDICATIONS SUCH AS ANTI HYPERTENSIVES,VASODIALATORS AND CONTRACEPTIVES3. RELAXATION TRAINING4. PROMOTE SLEEP IN SILENT ENVIRONMENT
PHARMACOLOGICALMainly pain killersDiclofenac sodiumAspirinAnxiolyticsThe treatment of the headache depends on the type and severity of the headache and on other factors such as the age of the patient
Health educationEnsure that the person and family members know the type of headache and treatment strategiesAvoid the precipitating factorsYoga