Neurology
Enriquez
Headache/Cephalgia
 Headache, or cephalalgia, is one of the most
common of all human physical complaints
 Headache is a symptom rather than a disease
entity; it may indicate organic disease
(neurologic or other disease), a stress response,
vasodilation (migraine), skeletal muscle tension
(tension headache), or a combination of factors.
Primary headache
 is one for which no organic cause can be
identified. This type of headache includes
migraine, tension-type, and cluster headaches
 Cranial arteritis is another common cause of
headache
 Benign and recurring
 No relationship to underlying cause
 Pain comes from inflammation of nerves, blood
vessels, and muscles
Secondary headache
 Sudden onset and extremely painful
 Commonly a result of underlying illness or
trauma
o a brain tumor, an aneurysm, or lumbar
puncture
 less common but much more serious and
involves additional symptoms
Types of headaches
1. Tension: muscle contraction associated with
tension or anxiety
 Bilateral pain; Blunt like pain located at
the back of the neck and over the top of
the head
 Lasts at least 30 minutes but can last
much longer, or several days
 Treated with rest, hydration, and OTC
pain medication
2. Migraine: vasoconstriction or spasm of cerebral
blood vessels (producing an aura) then
vasodilation
 characterized by periodic and recurrent
attacks of severe headache lasting from
hours to days in adults
 cause severe throbbing pain or a
pulsing sensation, usually on one side
(unilateral) of the head: Temporal area
 BP is elevated then leads to vasodilation
 Migraine aura associated with nausea,
sweating, irritability, and visual changes,
occurs within an hour before head pain
which lasts less than 60 minutes
 onset is at puberty, and the incidence is
higher in women than men
 treated with rest, isolation in dark, quiet
space, and OTC or Rx (Opioids and
Triptans) pain medications
3. Cluster: similar to migraine (vascular origin);
recur several times a day over a period of weeks
followed by remission lasting for weeks or
months
Ilah Reanne S.
 Remission—absence of signs and
symptoms for weeks or months
 Unilateral, intense throbbing pain
located at behind or around the eye
 Lasts for 30-90 minutes
 Abrupt onset; watery eye or runny nose
Predisposing Factor
 Stress
 Anxiety
 Depression
 Not getting enough sleep
 Missing meals
Triggered:
 Chocolate
 Cheese
 Monosodium glutamate (MSG)
Pathophysiology
 The cerebral signs and symptoms of migraine
result from a hyperexcitable brain that is
susceptible to a phenomenon known as cortical
spreading depression
o wave of depolarization over the cerebral
cortex, cerebellum, and hippocampus.
o depolarization activates inflammatory
neuropeptides and other neurotransmitters
(including serotonin), resulting in the
stimulation of meningeal nociceptors
 Vascular changes, inflammation, and a
continuation of pain signal stimulation occur
 Attacks can be triggered by hormonal changes
associated with menstrual cycles, bright lights,
stress, depression, sleep deprivation, fatigue, or
odors.
 Certain foods containing tyramine (especially
aged cheese), monosodium glutamate, and
chocolate
 use of oral contraceptives may be associated
with increased frequency and severity of attacks
in some women
 Emotional or physical stress may cause
contraction of the muscles in the neck and scalp,
resulting in tension headache.
Nursing Interventions
 Quiet, dark environment
 Identify factors that precipitate the attack
 Drink water
 Cool cloth on the head
 Relaxation technique
Medications: Aspirin and Acetaminophen
 Migraine
o Beta Blockers (-olol)
- Propranolol
- Atenolol
o Calcium Channel Blockers: (-depine)
- Amlodepine
o NSAIDs: Ibuprofen; Naproxen (-en)
 Prevention and treatment: drugs to prevent
migraine; to stop and relieve pain of migraine
Neurology
Clinical Manifestations
 The migraine with aura can be divided into four
phases: premonitory, aura, the headache, and
recovery (headache termination and
postdrome).
1. Premonitory phase—occur hours to days
before a migraine headache; may include
depression, irritability, feeling cold, food
cravings, anorexia, change in activity level,
increased urination, diarrhea, or constipation.
2. Aura phase—aura is characterized by focal
neurologic symptoms: Visual disturbances (i.e.,
light flashes and bright spots) and may affect
only half of the visual field; numbness and
tingling of the lips, face, or hands; mild
confusion; slight weakness of an extremity;
drowsiness; and dizziness
3. Headache phase—Migraine headache is
severe and incapacitating and is often
associated with photophobia (light sensitivity),
phonophobia (sound sensitivity), or allodynia
(abnormal perception of innocuous stimuli)
4. Postdrome phase—pain gradually subsides,
but patients may experience tiredness,
weakness, cognitive difficulties, and mood
changes for hours to days; Muscle contraction in
the neck and scalp is common, with associated
muscle ache and localized tenderness.
- Patient sleeps for extended periods
Head Trauma
 Traumatic brain injury (TBI) or craniocerebral
trauma describes an injury that is the result of an
external force and is of sufficient magnitude to
interfere with daily life and prompts the seeking
of treatment
Types:
 Concussions—jarring or movement of the brain
against the skull
 Contusion—due to the stronger impact, the brain
will bump against the skull leaving a bluish
discoloration on the brain tissues; worse than
concussions
 Laceration—tearing of tissues due to sharp
object that can result to hemorrhage which leads
to hematoma
 Compression of the brain—result from
depressed fracture of the skull that causes
hemorrhage and edema
Types of brain injury
 Coup—impact to the head; one side is affected
 Contrecoup—the brain will bump to the other
side of the skull; two areas are affected
 Coup-contrecoup—due to the stronger impact,
the brain creates a back-and-forth movement in
the skull
Ilah Reanne S. Enriquez
Assessment
 Signs and symptoms of increased in intracranial
pressure
 Signs of Basilar Head Injury
o Cerebral spinal fluid leaks from the ears
and nose
o Rhinorrhea consisting of clear liquid is
suggestive of a tear in the dura in a
client with Basilar skull fracture
o Raccoon’s eye and Battle’s sign
Management
 Care of the client with increased in ICP
 Monitor the client for the drainage from ears and
nose
 Monitor the client for signs and symptoms of
meningitis and pneumonia
Brain Tumor
 Growth of cells in the brain or areas near it.
Primary—tumors that originate from the tissues of the
brain’s immediate surroundings
 Secondary—metastasizing cancer cells
Types of Tumors:
 Glioma—50%; if the tumor is located at the
brain tissues or in spine
 Meningiomas—18%; tumor is located in the
meninges
 Neuroma—8%; swelling nerve that arises from
the nerve cells
 Hemangioma—a bundle of veins that branch
out together then will become dilated
Assessment
 Papilledema—swelling of both optic discs in the
eyes due to increased ICP; initial indication
 Headache—worst in the morning; straining and
stooping
 Vomiting—triad symptoms: papilledema,
headache, and vomiting
 Seizure—expected symptoms
 Changes in the mental status
Diagnostic exams
 CT scan and MRI—can locate the tumor and
also identify the size
Management
 Surgery: Craniotomy, Craniectomy
 According to location:
o Supratentorial—elevate the HOB up to
45 degrees to promote venous return;
tumor is located at cerebrum and 2/3
anterior of the brain
o Infratentorial—elevate the HOB 15
degree; may put pillow but never put
client on his back turn; located at the
cerebellum, brain stem, 1/3 posterior of
the brain
Neurology Ilah Reanne S. Enriquez
 Interruption of cerebral blood flow for 5 seconds
 Avoid neck flexion after operation or more causes death of neurons in affected
 Yellowish drainage of the head dressing—report area with irreversible loss of function
to AP; might be CSF mixed with blood
 Causes:
Medications: o Thrombosis
 Corticosteroid: o Embolism
o Dexamethasone (Decadron)—anti- o hemorrhage
inflammatory effect and reduces
cerebral edema
 Incision:
o Coronal—surgical approach to the
anterior cranial vault and upper and
middle third facial skeleton
o Butterfly—useful in cases that a wound
is large, uneven, or bleeding heavily.

Surgical Management:

 Craniectomy—surgical procedure wherein a

portion of the cranium is removed to relieve
pressure on the brain structures by providing
space for expansion
 Craniotomy—surgical procedure wherein the
cranial vault is opened to visualize and relieve
pressure on the brain

Reminders:

 Neutral position
 Turn head to side toward the unoperated side
 May put on the operative side but not more than
20 minutes
 May put pillow but never put client on his back

Cerebrovascular Accident (CVA)

 Interruption of cerebral blood flow for 5 minutes

or more causes death of neurons in affected
area with irreversible loss of function
 Brain attack—result of the interruption of the
blood supply
 Apoplexy—bleeding into an organ or loss of
blood flow to an organ
 CVD—Cardiovascular disease is the disease of
the heart or blood vessels.
 Stroke—obstruction to the blood supply to the
part of the brain or when a blood vessel in the
brain bursts

Stages of Development of CVA:

1. Transient Ischemic attack (TIA)—mini stroke

 No neurologic deficit remains
 Warning sign of impending CVA
 Brief period of neurologic deficit
 Blurred vision, Diplopia
 Transient numbness, Hemiparesis, slurred
speech aphasia, vertigo
 Lasts less than 30 seconds but no more
than 24 hours with complete resolution of
neurologic dysfunction

Cerebrovascular Accident (CVA), Brain attack, Stroke:

 Destruction of brain cells caused by reduction in

cerebral blood flow and oxygen