I. Headaches (pp. 1555–1558)
Headaches are classified as primary (not caused by disease) or secondary
(caused by another condition like a tumor or infection).
1. Tension-Type Headache (TTH)
● Characteristics: Most common type; bilateral, "bandlike" pressure at the base
of the skull.
● Quality: Constant, squeezing, tightness; mild to moderate intensity.
● Clinical Manifestations: No nausea/vomiting; may have photophobia (light
sensitivity) or phonophobia (sound sensitivity). No prodrome (warning signs).
● Treatment: * Symptomatic: Aspirin, acetaminophen, or NSAIDs alone or with
caffeine/muscle relaxants.
○ Preventive: Tricyclic antidepressants (amitriptyline), antiseizure meds
(topiramate).
2. Migraine Headache
● Characteristics: Recurring, unilateral (60%) throbbing pain synchronous with
the pulse.
● Etiology: Likely neurovascular events causing inflammation and vasodilation.
Triggers include stress, bright lights, smells, and foods (caffeine, red wine, aged
cheese).
● Phases:
○ Prodrome: Fatigue, irritability, or food cravings days/hours before.
○ Aura: Occurs in 25%; visual sparks, tingling, or zig-zag lines.
● Treatment: * Symptomatic: Triptans (e.g., sumatriptan) are first-line for
moderate/severe pain. Note: Contraindicated in patients with heart
disease/stroke due to vasoconstriction.
○ Preventive: Beta-blockers (propranolol), antiseizure drugs, or Botox
injections.
3. Cluster Headache
● Characteristics: Most severe primary headache. Sharp, stabbing, "bone-
crushing" pain centered around one eye.
● Patterns: Occurs in "clusters" (daily for weeks) followed by remissions. Often
starts at night.
● Clinical Manifestations: Swelling around the eye, tearing (lacrimation), nasal
congestion, and miosis (pupil constriction) on the affected side.
● Treatment: * Acute: 100% High-flow Oxygen (6–8 L/min for 10 min) or
triptans.
○ Preventive: High-dose Verapamil is the first-choice drug.
, II. Seizure Disorders (pp. 1558–1560)
A seizure is an uncontrolled electrical discharge of neurons in the brain.
1. Phases of a Seizure
1. Prodromal: Sensations or behavior changes (hours/days before).
2. Aural: Sensory warning (part of the seizure).
3. Ictal: From first symptom to the end of seizure activity.
4. Postictal: Recovery period (fatigue, muscle soreness, confusion).
2. Major Seizure Types
● Generalized Onset: Involves both sides of the brain.
○ Tonic-Clonic (Grand Mal): Loss of consciousness, falling, stiffening (tonic),
followed by jerking (clonic). Cyanosis and tongue biting may occur.
○ Absence (Petit Mal): Brief staring spells (mostly in children).
● Focal Onset: Starts in one specific area of the brain.
○ Focal Awareness: Patient remains conscious but feels unusual (joy, anger,
strange smells).
○ Focal Impaired Awareness: Dreamlike state; eyes open but unable to
interact; may perform repetitive actions (automatisms) like lip-smacking.
3. Complications
● Status Epilepticus (SE): A neurologic emergency where seizures recur in
rapid succession or last >5 minutes. Can lead to permanent brain damage.
○ Treatment: Rapid-acting IV lorazepam (Ativan) or diazepam (Valium).
III. Myasthenia Gravis (pp. 1568–1569)
MG is an autoimmune disease of the neuromuscular junction.
● Pathophysiology: Antibodies attack Acetylcholine (ACh) receptors, preventing
muscle contraction.
● Key Manifestation: Fluctuating weakness of skeletal muscles that
worsens with activity and improves with rest.
○ Commonly affects eyes (ptosis/drooping eyelids, diplopia/double vision),
chewing, swallowing, and breathing.
● Myasthenic Crisis: Acute exacerbation triggered by infection, surgery, or
stress. The main risk is respiratory failure due to weakened
diaphragm/intercostal muscles.
Interprofessional Care for MG
● Drug Therapy: * Anticholinesterase drugs: Pyridostigmine (Mestinon)—
prolongs ACh action.
○ Corticosteroids: Prednisone—suppresses immune response.
Headaches are classified as primary (not caused by disease) or secondary
(caused by another condition like a tumor or infection).
1. Tension-Type Headache (TTH)
● Characteristics: Most common type; bilateral, "bandlike" pressure at the base
of the skull.
● Quality: Constant, squeezing, tightness; mild to moderate intensity.
● Clinical Manifestations: No nausea/vomiting; may have photophobia (light
sensitivity) or phonophobia (sound sensitivity). No prodrome (warning signs).
● Treatment: * Symptomatic: Aspirin, acetaminophen, or NSAIDs alone or with
caffeine/muscle relaxants.
○ Preventive: Tricyclic antidepressants (amitriptyline), antiseizure meds
(topiramate).
2. Migraine Headache
● Characteristics: Recurring, unilateral (60%) throbbing pain synchronous with
the pulse.
● Etiology: Likely neurovascular events causing inflammation and vasodilation.
Triggers include stress, bright lights, smells, and foods (caffeine, red wine, aged
cheese).
● Phases:
○ Prodrome: Fatigue, irritability, or food cravings days/hours before.
○ Aura: Occurs in 25%; visual sparks, tingling, or zig-zag lines.
● Treatment: * Symptomatic: Triptans (e.g., sumatriptan) are first-line for
moderate/severe pain. Note: Contraindicated in patients with heart
disease/stroke due to vasoconstriction.
○ Preventive: Beta-blockers (propranolol), antiseizure drugs, or Botox
injections.
3. Cluster Headache
● Characteristics: Most severe primary headache. Sharp, stabbing, "bone-
crushing" pain centered around one eye.
● Patterns: Occurs in "clusters" (daily for weeks) followed by remissions. Often
starts at night.
● Clinical Manifestations: Swelling around the eye, tearing (lacrimation), nasal
congestion, and miosis (pupil constriction) on the affected side.
● Treatment: * Acute: 100% High-flow Oxygen (6–8 L/min for 10 min) or
triptans.
○ Preventive: High-dose Verapamil is the first-choice drug.
, II. Seizure Disorders (pp. 1558–1560)
A seizure is an uncontrolled electrical discharge of neurons in the brain.
1. Phases of a Seizure
1. Prodromal: Sensations or behavior changes (hours/days before).
2. Aural: Sensory warning (part of the seizure).
3. Ictal: From first symptom to the end of seizure activity.
4. Postictal: Recovery period (fatigue, muscle soreness, confusion).
2. Major Seizure Types
● Generalized Onset: Involves both sides of the brain.
○ Tonic-Clonic (Grand Mal): Loss of consciousness, falling, stiffening (tonic),
followed by jerking (clonic). Cyanosis and tongue biting may occur.
○ Absence (Petit Mal): Brief staring spells (mostly in children).
● Focal Onset: Starts in one specific area of the brain.
○ Focal Awareness: Patient remains conscious but feels unusual (joy, anger,
strange smells).
○ Focal Impaired Awareness: Dreamlike state; eyes open but unable to
interact; may perform repetitive actions (automatisms) like lip-smacking.
3. Complications
● Status Epilepticus (SE): A neurologic emergency where seizures recur in
rapid succession or last >5 minutes. Can lead to permanent brain damage.
○ Treatment: Rapid-acting IV lorazepam (Ativan) or diazepam (Valium).
III. Myasthenia Gravis (pp. 1568–1569)
MG is an autoimmune disease of the neuromuscular junction.
● Pathophysiology: Antibodies attack Acetylcholine (ACh) receptors, preventing
muscle contraction.
● Key Manifestation: Fluctuating weakness of skeletal muscles that
worsens with activity and improves with rest.
○ Commonly affects eyes (ptosis/drooping eyelids, diplopia/double vision),
chewing, swallowing, and breathing.
● Myasthenic Crisis: Acute exacerbation triggered by infection, surgery, or
stress. The main risk is respiratory failure due to weakened
diaphragm/intercostal muscles.
Interprofessional Care for MG
● Drug Therapy: * Anticholinesterase drugs: Pyridostigmine (Mestinon)—
prolongs ACh action.
○ Corticosteroids: Prednisone—suppresses immune response.
