Headache Cause

 Headache is a common presenting complaint to the emergency departmen (ED), representing 3% to 5% of all ED visits. Patients commonly present because they are experiencing a headache that is new to them or is more severe than anything they have sufferde in the past. Alternatively, they present to the ED as a last relort, having put up with their headache for years but never having sought medical attention. The actual incidence of life-threatening causes for headache is quite low. Headaches are common and frequently benign in late childhood and adolescence. However, they are uncommon in the young child and a more exhaustive search for an underlying cause may be warranted in this group.

     Headache symptoms may be caused by any pain-sensitive structure in the head. These include the skin and associated soft tissues; the periosteum of the skull; the tissues of the eye, ear and oral, and sinus cavities; the cranial nerves (V, IX, and X), the first three cervical nerves, parts of the meninges, or the intracranial blood vessels. The bones of the skull and the tissue of the brain are insensate. The varied nature of these structures gives rise to a large number of headache syndromes.
Headaches are generally divided into three categories: tension headaches, vascular, and traction and inflammatory. Tension headache due to constriction of the muscles of the neck and scalp. Typical causes for this limitation are psychologecal stress, arthritis, neck, or a defensive reaction to the adjacent muscle injury.
     Vascular headaches are probably the result of abnormal activity in the nerve cells of the path of the trigeminal nerve is. This triggers a complex cascade of events, including the release of vasoactive peptides, the most important is serotonin. The inflammation causes neurogenic vasodilation, which is a process of extravasation of plasma proteins. The strongest evidence for the effectiveness of these mechanisms is ergot and triptan migraine drugs to block the release of neuropeptides and in turn to treat headaches. Strangely, it is assumed that the process of neurogenic inflammation by many internal and external stimuli, including infectious material or irritation of the meninges, blood can be triggered. This means that the subarachnoid hemorrhage and meningitis, among other causes of headaches that share a common pathophysiological path. This may explain why are patients with subarachnoid hemorrhage and relieve headaches, since some medications for migraine headaches in context. Vascular headaches are considered hypertensive. It should be noted that until the abolition of diastolic blood pressure above 120 mm Hg is htought contribute significantly to pain thadache ..
     Traction headaches are caused by mechanical forces on the intracranial structures; examples are tumors, and large amounts of blood. Also, consider diseases of the eyes, ears, nose, and teeth. Inflammatory causes include temporal arteritis, phlebitis, and cranial neuralgias.
    Despite a reasonable effort to break the cycle of pain should be done, a complete relief of pain is not often achieved with the ED. Realistic expectations should be with the patient and a management plan will be discussed after the closure must also be done. The patient should be given a plausible explanation of the origin of headaches, including processes, which were during the visit of erectile dysfunction rejected. Discharge Instructions for benign causes of headache have a plan to manage the pain continues, derected monitoring, and the discussion about the signs and symptoms should report ED.

Clinical Scenario
    A 33-year-old woman who came to the emergency department (ED) and complained of severe headache, vomiting and visual disturbances. He says it is the headache suddenly after dinner watching TV. Vomited twice shortly after the onset of the headache. The headaches were so strong, he thought he was black pain. Review of systems, say they feel obliged, neck and bright fluorescent lights are back irritates the eyes. He has no fever, weakness or numbness. He denies trauma or violence in the family. A strong family of migraine has been used, the headache headache is different than any before. History was unremarkable. Taking oral contraceptives and had no known drug allergies. She does not smoke, drugs or alcohol. Her last menstrual period was two weeks ago. The physical examination revealed a woman in front of moderate distress. Vital signs showed a blood pressure of 190/108 mmHg, pulse 108 beats per minute rates, respiration 20 breaths per minute and a temperature of 98.9 ° C. His oropharynx and ears are normal. Heart, lung and abdominal examination were normal. In the neurological examination, complained of blurred vision, but not to be more precise, the visual acuity was 20/25 in both eyes. The eyes have pupils are equal and reactive, extraocular movements intact, and the fundus examination was normal. There is a slight photophobia shining light in the eyes of the patient. Cranial nerves II to XII, otherwise normal. The force is maintained in all extremities with normal reflexes and equal treatment. Sensation is intact to touch, prick, and proprioception bilaterally. Balance and walking are normal. The patient was treated with intravenous prochlorperazine for vomiting and are subject to a non-contrast computed tomography (CT) of the head. The procedure is well tolerated, but by returning to the ED complaining party of severe headache and persistent visual impairment. He received meperidine for analgesia. The scan is normal, the absence of intracranial masses or blood. A lumbar puncture (LP) gives the clear liquid the color of blood Hawaiian Punch. The color remains constant throughout the set of four tubes. The analysis of 624 000 cells showed red blood cells (RBC) / ml and 580 000 l tube red cell / ml 4 in Tube The patient was admitted to the intensive care unit (ICU) with a diagnosis of subarachnoid hemorrhage (ESA) for the alleged absence of an aneurysm. And “scheduled for cerebral angiography, neurosurgery and consultation. The patient with frequent neurological examinations and blood pressure monitors with intravenous nitroprusside. The patient is a successful underwent surgery by cutting off the aneurysm and was on the third day fired at the hospital in good condition ..

Clinical Evaluation

Introduction
Despite progress in diagnosis and treatment procedures, HSA is always a mortality of 35% to 40%, only a slight decrease in the mortality rate of 50% before 30 years. Survivors often with permanent neurological sequelae left, it is often able to return to their lives Preble. Unfortunately, were over 25% of patients later diagnosed diagnosed in September of their first presentation. Many Thanks to its high morbidity and mortality, HSAs must be diagnosed and treated properly.