This document discusses various structures in the head and neck that are sensitive to pain, including the skin, muscles, arteries, cranial nerves, and parts of the brain. It notes that pain from the middle meningeal artery is felt in the back of the eye and temple, while pain from the internal carotid artery and cerebral arteries is felt in the eye and temple. It also discusses mechanisms for transmitting sensory stimuli to the central nervous system and factors involved in evaluating patients experiencing headaches, vertigo, faintness, and syncope.

1. Angelo B. Juan, M.D.,
MHSA, FPCHA
HEADACHE

3. Cranial structures sensitive to pain
> Skin subcutaneous tissues, muscles, extra –cranial arteries, perosteum
of the skull.
> Structure of the eyes, ears, nasal cavities, sinuses.
> Intra cranial venus sinuses and tributaries.
> Parts of the dura at the of the brain and the arteries within the Dura and
Pia-arachnoid particularly the proximal parts of the anterior and middle
cerebral arteries arteries and the intracranial segment of the internal carotid
artery
>Middle meningeal and superficial temporal arteries.
>Optic, oculomotor, trigeminal, glossopharyngeal, vagus and the first three
cervical nerves.

4. • The reference sites of pain from these structures:
Pain impulses that arise from distention of the
middle meningeal artery are projected to the back
of the eye and temporal area.
• Pain from the intracranial segment of the internal
carotid artery and proximal parts of the middle and
anterior cerebral arteries is felt in the eye and
orbitotemporal regions.

5. Cranial Structures which lacks sensitivity

6. Pathways whereby sensory stimuli are transmitted to
the CNS

8. MECHANICS OF CRANIAL PAIN

11. GENERAL CONSIDERATIONS

18. EVALUATION OF THE PATIENT WITH HEADACHE

21. IS THERE A VISUAL OR OTHER PRODOME?

23. When do Headache occur?

25. WHAT FACTORS MAKE THE HEADACHE BETTER OR
WORSE?

26. DOES MEDICATION AFFECT
THE HEADACHE?

27. HOW LONG DOES THE HEADACHE LAST?

28. IS DEPRESSION A FACTOR?

29. EXAMINATION OF THE PATIENT WITH
HEADACHE

32. VERTIGO-DIZZINESS

34. Careful History

35. IS THE LESION PERIPHERAL OR CENTRAL ?

37. PERIPHERAL VS CENTRAL NYSTAGMUS

38. IS THE LESION PERIPHERAL

39. MENIER’S DIS.

40. BENIGN PAROXYSMAL POSITIONAL VERTIGO

41. ACUTE LABYRINTHITIS

42. VESTIBULAR NEURONITIS

43. POST-TRAUMATIC VERTIGO

44. DOES THE LESION BEGIN PERIPHERALLY AND
THEN SPREAD CENTRALLY?

45. IS THE LESION CENTRAL?

48. IS THE LESION SYSTEMIC?

50. FAINTNESS AND SYNCOP

51. FAINTNESS AND SYNCOPE

52. CLINICAL FEATURES

55. CAUSES

56. I. Neurogenic Vasodepressor and
vasovagal rxns

57. II. Sympathetic N.S. Failure (Postural-
Orthostatic Hypertension)

59. III. Reduced Cardiac Output or inadequate intravascular
volume (Hypovolemia)

60. IV. OTHER CAUSES

62. NEUROGENIC SYNCOPE

63. VASODEPRESSOR SYNCOPE

64. NEUROCARDIOGENIC SYNCOPE

65. EXERCISE- INDUCED SYNCOPE

66. CAROTID SINUS SYNCOPE

68. SYNCOPE IN ASSOCIATION WITH GLOSSOPHARYNGEAL
NEURALGIA

69. MICTURITION SYNCOPE

70. TUSSIVE and VALSALVA SYNCOPE

74. FAILURE OF THE SYMPATHETIC NEUROCARDIOGENIC
SYNCOPE

78. PRIMARY AUTONOMIC INSUFFICIENCY (IDIOPATHIC
ORTHOSTATIC HYPOTENSION)

79. SYNCOPE OF CARDIAC ORIGIN

82. END OF LECTUR
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