Headaches can result from allergies, sinuses, tension, arthritis, and TMJ.

3 Classification of Headaches

Vascular: Migraine, Cluster and hypertension

Tension: Psychological (tension or stress) or Medical problems (cervical arthritis)
Traction-inflammatory: Infection, intracranial and extra, occlusive vascular
structures

Migraine: vasoconstriction then dilation of cerebral arteries. Often begin with visual
disturbances (photophobia).
Tx: Reglan. Triptans are first line of tx by helping already dilated blood vessels constrict
Cluster/Alarm/Suicide: abrupt onset w no warning signs, typically start in the night.
Occur in clusters of time spans. Alcohol worsens the episodes. Caused by Vascular
disturbances, stress and emotional distress.
Tx: NSAIDs, dark room, cold compress may help but also worsen. Avoid opiates
(rebound headaches)
Tension: persistent contraction of scalp, facial, cervical and upper thoracic muscles.
Associated with Period, anxiety and depression. Involves head and neck.
Tx: relaxation techniques, Massage and non-opioids
Tests for headaches: neurological examination, CT Scan.
Foods that trigger headaches: MSG, artificial sweeteners and meats with nitrates (bacon),
chocolate, aged cheese
NI: Give meds, rest, decrease stress, application of cold to forehead, dark rooms
Neuropathic (Chronic) Pain
Intractable pain: Phantom: unbearable and does not respond to tx
Increased Intracranial Pain
Pressure exerted inside the cranial cavity by Blood, Brain and CSF. Norm ICP = 0-15.
Can be a result of brain trauma, surgery, Intracranial hemorrhage and tumors. Occurs
slowly from tumor or fast from trauma.
S/S: Decreased LOC, restlessness, irritability, disorientation, lethargy
Oculomotor Never Compression

Diminished reactivity of the pupil (unilateral)

Pupil dilates (unilateral)
No reaction to light (unilateral)

Bilateral pupils become fixed and dilated as the other side of brain become
involved (Blown pupils)

VS Changes: Crushing Triad (bradycardia, arterial hypertension[wide pulse- systolic

increases and diastolic remains the same], irregular respirations)
Pathophysiology of increased ICP
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Brain tissue injury occurs

Inflammation
Increased pressure
Decreased cerebral blood flow
Ischemia and hypoxia of brain tissue
Vasodilation
Wide pulse
Supratentorial shift

Early signs of ICP

Decreasing LOC, personality change, double vision, dull headache in AM, vomit w/o
nausea.
Later Signs of ICP
Papilledema swelling of the optic nerve from interference w venous drainage of eye and
Crushing Triads (VS)
Decorticate: flexion (nonfunctioning cortex)
Decerebrate: extension (brainstem lesion)
Singultus: hiccups herniation and compression of the vagus nerve
Tx: Corticosteroids for inflammation, diuretics to pull H2O from affected area to
decrease fluid on brain.
NI: HOB 30-45 supine, restrict fluids, avoid valsalvas maneuvers
Disturbances in muscle tone and motor function
Motor neurons take impulses to skeletal
Diagnostics: EMG to look for Multiple Sclerosis, ALS, Myasthenia gravis
NI: safety, activity and nutrition needs, ADL, psychological adjustment
Agnosia: inability to recognize objects or persons

Epilepsy/Seizures
May affect all or part of the body.
Tonic: continued contraction of all muscles, rigid
Tonic-Clonic: alternate contraction, rhythmic jerking. Grand Mal (presence of an aura
that precedes the seizure
Absence: Petit Mal
Reasons Seizures occur: trauma, tumor, hypoglycemia (brain needs glucose).
Status Epilepticus: continuous seizures or repeated seizures in rapid succession for
30mins or more.
Tx: Dilantin, Depakote, tegretol. Impaired Vita D leads to Calcium imbalance
NI: turn head to side to prevent aspirations, do not restrain
Document: b4 seizure, what caused it, how long did it last, parts of body involved, VS
Multiple Sclerosis
Degenerative neuro disease, cause is unknown. T cells found in spinal fluid.
T cells defend against intruders. In MS T cells attack their own body
Demyelination: myelin sheath and cells are destroyed. Hard plaque like lesions replace
the destroyed myelin.
S/S: motor and sensory dysfunction, problems w coordination, mental changes, fatigue
Periods of remission and exacerbation
Assessment: Pain is not common, Diplopia (double vision), seeing spots, blindness,
nystagmus, dysphagia.
NI: High fiber, change pos freq, exercise and bedrest, Avoid Heat
Baclofen: muscle spasticity and Rigid
Parkinsons
Progressive neuro disease, Shaking Palsy. Rare in blacks. No cure. Intellectual ability is
not impaired. Diet high in fiber to prevent constipation
A decreased production of dopamine, which is needed for the control of posture, support
and voluntary motion
Normally dopamine and acetycholine are balance in the brain. Parkinsons interrupts this.

S/S: tremors, muscle rigidity and bradykinesia (slow movement), Pill Rolling,
Hypophonia ( low vol of speech), micrographia (small handwriting)
Dopamine connot cross the blood brain barrier but levodopa can and once across it is
converted to dopamine. protein affects its absorption.
Alzheimers
Impaired intellectual dunctioning, degeneration of the cells of the brain. Loss of the
ability to perform tasks that require ACh
An elevated plasma level of homocystenie is associated with Alzheimers. Lower levels
by eating food rich in Folic Acid (fruits and green leafy)
1st symptom is memory loss
NI: finger foods, freq feedings, constant supervision

Anomia: trouble remembering words

Agraphia: unable to write down own thoughts
Aphasia: trouble verbally expressing self
Alexia: trouble understanding written language
Agnosia: inability to recognize objects or persons
Apraxia: cannot put on shirt, althought muscle and motor movement are fine.
Myasthenia Gravis

Neuro junction autoimmune disease. Aggravated by activity and relieved by rest.

Lack of ACh acetylcholine.
Never impulses do not pass through the myoneural junction
Unilateral ptosis: drooping of the upper eyelid, Diplopia.
Skeletal muscle weakness: hallmark sign increased muscle weakness during activity.
Improved strength after rest.
IV injection of tensilon, muscle function will improve in a short period of time
NI: teach chin tuck and double swallow to prevent airway obstruction and aspiration
Amyotrophic Lateral Sclerosis
Lou Gehrigs Disease: affects motor neurons responsible for voluntary muscle control.
Death within 2-5Y. Onset 40-70YoA. Affects twice as many men.
No specific lab test and no cure. Rilutek adds 3months to life
Cognitive unction remains intact. They are aware of their surroundings

Huntingtons Disease
Hereditary, CNS w progessie loss of norm movement and intellect.
Overactivity of dopamine
S/S are opposite of parkinsons: dancelike movements (choreiform), Death within 10-20Y
NI: provide comfort, amotional and psychological. High Cal diet 4/5000, thickening
agents, soft foods.
Cerebrovascular Accident (brain attack)
Stroke, lack of O2 for 3-7mins the brain and its cells begin to die
Cerebellum: balance and coordination
Brain Stem: breathing, BP and HR
Meds to reduce ICP: Decadron
Ischemic Stroke: formation of an embolus or thrombus. 80-85% of all stokes. Appear
w/o warning.
Thrombotic: caused by plaque buildup w the formation of a clot. #1 cause of
stroke and athrosclerosis. Occurs during sleep or soon after wakening
Embolic: a blood clot or debris circulating in a blood vessel
Tx: Tissue Plasminogen Activator. MERCI up to 8h
Hemorrhagic Stroke: bleeding into the brain. #1 cause is aneurysm. Also caused by
Arteriovenous Malformation: tangled mass of malformed, thin walled dilated vessels that
form an abnormal communication between arteries and veins.
The eyes deviate towards the affected side of brain
Tx: Craniotomy to repair aneurysm, place in semi-fowlers
Nicotine is a vasoconstrictor
Hemiparesis: slight paralysis one side of the body
Hemiplegia: paralysis of one side of the body
Stroke right side of brain, left side paralysis, food on left side is not seen

Trigeminal Neuralgia

Tic Douloreux. Rare facial pain syndrome. Pressure on nerve root by a tumor.
Burning pain radiating on 5th cranial nerve (trigeminal) causes twitching of face.
Bells Palsy
Facial weakness or paralysis caused by inflammation involving cranial nerve VII, herpes,
3rd trimester of pregnancy
72 hours?
Guillain-Barre Syndrome
Inflammation and demyelination of PNS caused by autoimmune response to some type of
viral infection or to certain vaccines.
Progressive muscle weakness and paralysis in all ages. Starts in lower and moves up.
CSF exam shows elevated protein level.
Tx: Plasmapheresis: plasma is removed and washed to remove antibodies bc they attack
schwann cells.
Meningitis
Increased temp, sever headache, nuchal rigidity (stiff neck)
Bacterial Meningitis Signs: Kernigs and Brudzinski
Kernigs: inability to extend leg when thigh is flexed on abs
Brudzinski: flexion of the neck produces flexion of the knees and hip
CSF is norm clear, bacteria causes it to become purulent
Encephalitis
Acute inflammation of brain caused by viral, transmitted by tick and mosquitos
Also caused by measles, chicken pox or mumps
Cytomegalovirus encephalitis is a complication in pt w AIDS
CSF increased WBC, yellow colored from breakdown of blood

West Nile Virus

Obtained by the bite of an infected

female mosquito

HIB: 2,4,6,12-15 months

Menactra: 11-12 booster @ 16

DEET not for children under 2months

Brain Abscess
Accumulation of pus within the brain tissue caused by direct extension from infections of
the ear or tooth. Staph or Strep
Tumor
Take up space and block the flow of SPF
Symptoms of ICP: classic triad (headache, vomit, papilledema)
Gliomas: brain
S/S: Subjective: unusual odor, headache in AM, hearing loss, inability to carry out daily
Craniotomy: surgical opening through the skull- the removed portion of the bone is
replaced.
Craniectomy: removal of part or a segment of the skull w/o replacement
Gamma-Knife Radiosurgery: noninvasive
NI: shave the hair
Cranialcerebral Trauma
The amount of obvious damage is not indicative of the seriousness of the trouble.
Open: skull fracture

Closed: concussion

Epidural hematoma: arterial bleeding, blood collects rapidly between the dura and the
skull
Subdural hematoma: benous bleeding, blood collects below the dura, Slow
o Acute: 24-48h
o Sub-acute: 48-2w
o Chronic: 20 days or more
S/S: Battles Sign: small hemorrhagic area behind the ear indicating lower skull bone fx.
Raccoon eyes, rhinorrhea, halo sign
NI: never suction through nose
Spinal Cord Trauma
Males 18-25
Tetraplegic: injury to cervical area C8 and above
Paraplegic: injury to the thoracic T1 and below