- Trigeminal neuralgia is characterized by sudden, severe facial pain that occurs in the areas of the face served by the trigeminal nerve. The pain is often triggered by light touch or other minor stimuli. Examination will reveal no sensory deficits. Treatment options include pharmacotherapy, microvascular decompression, or trigeminal ganglion block/radiofrequency ablation.
- Cluster headache is a severe headache occurring as multiple attacks and characterized by excruciating unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes if untreated. Attacks are associated with ipsilateral cranial autonomic features and a sense of restlessness. Treatment involves acute abortive therapy with oxygen or triptans and prevent
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
cluster headaches are also called as
Familial cluster headaches
Histamine cephalalgia
Vasogenic facial pain
Horton’s Syndrome
Cluster headache (CH) is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye.
A cluster headache commonly awakens paitent in the middle of the night with intense pain in or around one eye on one side of head.Cluster headache often accompanied with eye watering, nasal congestion, or swelling around the eye, on the affected side. These symptoms typically last 15 minutes to 3 hours.
The starting date and the duration of each cluster period might be consistent from period to period. For example, cluster periods can occur seasonally, such as every spring or every fall.
Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops
Headache Attributed to Nonvascular, Noninfectious
Intracranial Disorders
Headache Attributed to Trauma or Injury to the Head
and/or Neck
Headache Attributed to Infection
Headache Attributed to Cranial or Cervical Vascular
Disorders
Headache Associated with Disorders of Homeostasis
Headache Caused by Disorders of the Cranium, Neck,
Eyes, Ears, Nose, Sinuses, Teeth, Mouth, or Other
Facial or Cranial Structures
Headaches and the Cervical Spine
Migraine
Chronic Daily Headache
Cluster Headache
Other Trigeminal Autonomic Cephalalgias
Other Primary Headaches
cluster headaches are also called as
Familial cluster headaches
Histamine cephalalgia
Vasogenic facial pain
Horton’s Syndrome
Cluster headache (CH) is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye.
A cluster headache commonly awakens paitent in the middle of the night with intense pain in or around one eye on one side of head.Cluster headache often accompanied with eye watering, nasal congestion, or swelling around the eye, on the affected side. These symptoms typically last 15 minutes to 3 hours.
The starting date and the duration of each cluster period might be consistent from period to period. For example, cluster periods can occur seasonally, such as every spring or every fall.
Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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4. " I was standing in the shower with the hot water
spraying on my face. It was a fast, jarring jolt of
lightning pain on the left side of my face. For the
next couple of weeks I was immobile. All activities
and interest stopped. My time was spent waiting
apprehensively for the next jab of staggering pain
to hit my face. I dreaded waking up to start another
day of electrical-like pains."
5. The distinguishing features for classical TN are:
Character and location of the pain
Light touch provocation
Examination will reveal patients will have no sensory deficit.
Trigeminal Neuralgia
- Classical Clinical Features
6.
7.
8. Exhibit tactile trigger areas within the trigeminal distribution
- which will precipitate an attack when stimulated.
There are rarely autonomic features.
Triggers include:
Washing face
Shaving
Eating
Brushing teeth
Applying make-up
Talking
Cold wind
To confirm an accurate diagnosis, several provoking factors are usually needed.
9. • Location: Trigeminal Nerve. Predominantly affecting V2
and V3 distributions. Unilateral 97%.
• Age: any, most commonly over 50 years
• Gender: more in women
• Quality: sharp, stabbing or electrical
• Temporality: paroxysmal, remissions and recurrences
• Trigger Zone: often remote to pain, commonly nasolabial
• Trigger stimuli: slight touch, wind, speaking, brushing teeth
• Neurological Examination: NORMAL
Trigeminal Neuralgia
15. Distinct group of patients who have a form of facial neuralgia that has all the
characteristics of tension-type headache, except that it affects the midface;
- it is called midfacial segment pain.
Pain is described as a ‘feeling of pressure’, although some patients feel that their
nose is blocked when they have no nasal airway obstruction.
Mid facial segment pain is symmetric; it might involve areas of the nasion (the
root of the nose), under the bridge of the nose, on either side of the nose, the
peri- or retro-orbital regions, or across the cheeks.
There might be hyperesthesia of the skin and soft tissues over the affected area.
Nasal endoscopy and CT scans are typically normal.
Most respond to low-dose amitriptyline, but noticeable improvement might require
up to 6 weeks.
Mid Facial Segment Pain
17. Case
• A 32 year old joiner presented at 6.25 am to A&E
with an unbearable headache.
• He had been awoken from sleep with an
excruciating left retro-orbital pain. The headache
was associated with photosensitivity on the left
side.
• His headache had woken him about 60 mins
early.
• He described feeling that he wanted to “bash his
head” on the wall. His headache had settled
spontaneously by the time you arrived.
19. Trigeminal Autonomic
Cephalalgias
Cluster Headache
Paroxysmal Hemicrania
SUNCT
Short-lasting
Unilateral
Neuralgiform headache with
Conjunctival injection and
Tearing
orSUNA
Short-lasting
Unilateral
Neuralgiform headache with
Autonomic Features
Unilateral head pain,
predominantly V1
Excruciating
Cranial autonomic
symptoms
Parasympathetic
hyperactivity
Sympathetic deficit
Attack frequency and
duration differs
Treatment responses differ
Highly disabling disorders
20. Trigeminal Autonomic
Cephalalgias
Cluster Headache
Paroxysmal Hemicrania
SUNCT
Short-lasting
Unilateral
Neuralgiform headache with
Conjunctival injection and
Tearing
orSUNA
Short-lasting
Unilateral
Neuralgiform headache with
Autonomic Features
Unilateral head pain,
predominantly V1
Excruciating
Cranial autonomic
symptoms
Parasympathetic
hyperactivity
Sympathetic deficit
Attack frequency and
duration differs
Treatment responses differ
Highly disabling disorders
21. Cluster Headache
• Severe
• Unilateral
• Orbital, supraorbital or
temporal pain
• 15-180 minutes
duration
• Attack frequency
ranging from 1 every
other day to 8 daily
• Associated symptoms:
-Conjunctival injection
-Lacrimation
-Ptosis
-Miosis
-Eyelid oedema
-Nasal congestion
-Rhinorrhea
-Forehead and facial
sweating
• Sense of restlessness or
agitation during
headache
22. Paroxysmal Hemicrania
• Severe
• Unilateral
• Orbital, supraorbital
or temporal pain
• 2-30 minutes
duration
• >5 attacks daily at
least 50% of the time
• Associated symptoms:
-Conjunctival injection
-Lacrimation
-Ptosis
-Miosis
-Eyelid oedema
-Nasal congestion
-Rhinorrhea
-Forehead and facial
sweating
• Stopped completely
by indometacin
25. Acute Treatments for Cluster Headache
Time= 15min 15 min 30 min 30 min
N= 150 134 77 69
Cohen et al, JAMA 2009; van Vliet J et al, Neurology 2003; Cittadini E et al. Arch Neurol 2006; Ekbom K et al.
Acta Neurol Scand. 1993
• Randomised, controlled, double blind studies in cluster headache
*
*
*
*
*P<0.05
26. Verapamil in the preventive treatment of cluster
headache
Leone M et al. Neurology. 2000.
* p < 0.001 vs
placebo
N=30
6/15 0/15
12/15 0/15
*
*15 15
27. Cluster Headache
PREVENTIVE TREATMENTS
Verapamil
• Usually 240-480mg daily
• Up to 960mg daily
• 80-120mg increments
every 10-14 days with ECG
monitoring
Constipation
Nausea and vomiting
Fatigue
Pedal oedema
Bradycardia
Hypotension
Cardiac arrhythmias
Gabai I & Spierings E, Headache, 1989; Leone M et al., Neurology. 2000
28. Management of Cluster Headache
Abortive Treatment
oxygen and/or a subcutaneous or nasal triptan for the acute treatment of
cluster headache.
When using oxygen:
use 100% oxygen at a flow rate of at least 12 litres per minute with a non-
rebreathing mask and a reservoir bag and
arrange provision of home and ambulatory oxygen.
When using a subcutaneous or nasal triptan, ensure the person is offered an
adequate supply
two subcutaneous injections daily or
three nasal sprays daily
Do not offer paracetamol, NSAIDS, opioids, ergots or oral triptans for the
acute treatment of cluster headache.
http://guidance.nice.org.uk/CG150
29. Cluster Headache
PREVENTIVE TREATMENTS
Doses Comments
Verapamil 240-960mg/d ECG monitoring required
Lithium 400-2000mg/d
(0.8-1.0mM)
Regular serum lithium levels, thyroid function
and renal function checks
Methysergide 3-12mg/d Monitoring for visceral fibrosis
Topiramate 50-800mg/d
Gabapentin 900-3600mg/d
Melatonin 9-15mg/d
Valproate 600-2000mg/d
30. Cluster Headache
TRANSITIONAL TREATMENTS
Corticosteroids
• Rapid onset of action and highly effective at high doses
• Attacks recur once the dose is decreased
• Indications:
– Initial add-on until other preventatives effective
– Short-term use for multiple daily attacks
• Prednisolone regime
– 1mg/kg (up to maximum of 60mg) od for 5 days
– Taper thereafter over 2-3 weeks
– Simultaneously introduce a suitable prophylactic
Couch J and Ziegler D, Headache 1978
31. Migraine
• Unilateral throbbing followed by dull
ache
• Painful
• Can have aura phase (visual,
sensory etc..)
• Associated nausea photophobia,
phonophobia
• Drive to lie down in dark room and
sleep
• Can wake from sleep
• Wiped out for days sometimes
“hangover” phase with general
dysfunction
• Attack frequency usually no more
than 1 per every few days or every
day (ie transformed migraine NOT
CLUSTER)
Cluster
• Strictly unilateral with stabbing or
boring quality
• Excruciatingly severe!
• No aura phase usually
• Associated trigeminal autonomic
features (eyelid oedema, conjunctival
injection, tearing blocked nose etc)
• Pacing behavior around room;
agitated ++
• Typically alarm clock headache in
early hours of am
• Attack frequency 1-8 per day
32. • sharp, stabbing pains occurring as a single stab or as a series of stabs,
• occurring mostly in the eye and orbit, temple, or parietal regions.
• Stabs last a few seconds, and may recur throughout the day, usually at
irregular intervals.
• occurs more commonly in migraine sufferers.
• official term is Primary Stabbing Headache.
• also been referred to as "jabs and jolts headache”
• NB no autonomic disturbance and no trigger points..
‘Ice Pick Headaches’
33. • occur exclusively at night, wakes from your sleep at the same time,
usually between 1 and 3 am.
• nick named “alarm clock headache”.
• can be unilateral or bilateral
• Pain is throbbing although not everyone experiences this.
• Pain begins abruptly and can last from 15 minutes to 6 hours, although
typically it is about 30-60 minutes.
• more common amongst women than men.
• N.B. pain is not associated with autonomic features (such as a blocked
nose or watering eyes).
• Similarly, nausea, photophobia and phonophobia are not usually
associated with hypnic headache.
Hypnic Headache