中国医科大学神经病学英文课件 hedache.pptVIP

Headache Zheng Dongming The most common symptom in clinic the causes are myriad. Pathophysiology of headache Pain-sensitive structure: periosteum of the skull,skin,subcutaneous tissues muscles,blood vessels venous sinuses,dural arteries,arteries at the base of the skull. The trigeminal,glossopharyngeal,vagus,the second and third cervical nerves Principle : 1.history is very important in the diagnosis of headache. 2.physical examinatin 3.CT ,MRI,lumbar puncture. Migraine Migraine is characterized by an episodic unilateral throbbing headache . It is a common idiopathic headache seen in clinic. 2/3~3/4 women onset early. 55% 20 years of age 90% 40 family histry Etiology Genetics:approximately three-quarters of patients who suffer from migraine have close relatives similarly affected. Endocrine and metabolic factors:menstruation. Cheese, chocolate, sherry and red wine are common precipitants. Others:bright lights ,loud noise ,exercise ,hunger,emotional stress and anxiety Pathogenesis vascular theory:some studies e.g. PET scans of migraineurs, suggest that the aura is due to an spreading area of vascoconstriction over the brain .there is some evidence that the headache in migraine is due to subsequent vasodilatation of blood vessels .the association of stroke with migraine supports a vascular aetiology. neuronal theory: aura are associated with spreading neuronal inhibition which does not respect vascular territories .neuronal dysfunction could be the cause of the spreading vasoconstriction 5-HT.etc Clinical features A.migraine with Aura(classic Migraine) prodrome : a vague change in mood or appetite,sensitivity to light and sound aura : visual disturbance: Scintillating scotoma, the visual symptoms usually occupying one vi