3-10. COMMON NERVOUS SYSTEM DISORDERS

a. Vascular Headaches.

(1) Migraine headache. The exact cause of migraine headaches is unknown. An individual may have inherited a tendency for migraine headaches. Other possible causes include emotional stress, hypersensitivity, and the body's vascular mechanism of dilation of extracranial and intracranial arteries.

(a) Signs/symptoms of migraine headaches. Included are the following:

1 Paroxysmal (sudden onset) of headache, often preceded by psychologic or visual disturbances. The headache may be unilateral (on one side of the head) or bilateral (on both sides of the head).

2 Dizziness.

3 Commonly, sharp pains in the frontal region of the head, especially at the temple.

4 Excessive sweating, nausea, and vomiting.

5 Hypersensitivity to light and sound.

(b) Treatment of migraine headaches. It is important to take medication early on in a migraine headache attack. Ergotamine tartrate (Gynergen) is the drug of choice for this condition. Ergotamine tartrate stimulates the smooth muscle of the blood vessels to constrict. The dosage is 2 mg orally or 0.25 mg intramuscularly or subcutaneously. CAUTION: This medication can build up in the patient's body causing ergotism. (Ergotism is poisoning from excessive use of medicinal ergot.) Signs and symptoms of ergotism include numbness/tingling of fingers or toes, muscle pain and/or weakness, gangrene, and blindness. Another ergotamine preparation is ergotamine and caffeine (Cafergot). Ergotamine, phenobarbitol, and belladone (Cafergot P-B) are effective therapy for migraine headache complication by tension and gastrointestinal upset. A general aid for a migraine headache is to have the patient sit or lie down in a darkened, quiet room for one to two hours. The darkened room is used because of the sensitivity to light experienced by a patient with a migraine headache.

(2) Cluster headache (Morton's syndrome). The cause of this disorder is similar to that of a migraine headache. The exact cause of a cluster headache is unknown. Sensitivity to histamines may be a cause of this type of headache.

(a) Signs/symptoms of a cluster headache. Included are the following:

1 Severe and frequent attacks of short duration, usually in "cluster or group." The headaches may occur daily or several times a day for several weeks. The headache problem may resolve itself for a few months, then recur.

2 The headache may occur at the same time of day and on the same side of the head behind one eye.

3 Pain is accompanied by a tugging, pulling, or pressing sensation behind one eye.

4 Noticeable signs include nasal congestion, excessive tearing of the eye, and possibly one "bloodshot" eye.

5 Length of time of the headache may be from a few minutes to hours but usually not more than two hours. The average duration of such a headache is 30 to 90 minutes.

(b) Treatment of a cluster headache. Treat with ergotamine tartrate (Gynergen). Ergotamine tartrate will relieve a cluster headache quickest if given by intramuscular injection (may cause vomiting) or administered sublingually. Oral medications which are available act too slowly to be of much help. Usually, this type of headache lasts such a short time that medication does not have time to be effective.

(3) Hypertensive headache. Increased blood pressure causes a hypertensive headache.

(a) Signs/symptoms of a hypertensive headache. Included are the following:

1 Throbbing.

2 Sudden onset, frequently at the top of the head but may also be generalized in the head.

3 Elevated blood pressure and retinal hemorrhages.

(b) Treatment of a hypertensive headache. Lower the blood pressure by giving a combination of analgesic (pain killer medication) and tranquilizer. Try to find out the cause of the raised blood pressure.

(4) Muscle tension headache. Tension and emotional stress cause this type of headache. What happens is that the muscles in the neck and the scalp contract causing pain.

(a) Signs/symptoms of muscle tension headache. Such a headache is usually characterized by steady pain which is non- throbbing. The pain may be on one or both sides of the head but is often in the frontal region of the face.

(b) Treatment of muscle tension headache. Treatment consists of mild analgesic, rest, and removal of the situation which produced the anxiety.

b. Vascular Disorders. Vascular disorders include stroke, cerebrovascular accidents (CVA), and cerebral apoplexy. Vascular disorders of the central nervous system are defined as a sudden loss of brain function or a disruption of blood flow to the brain. This loss or disruption may result in impairment in motor, sensory, or mental functions.

(1) Causes of vascular disorders. Included are the following:

(a) Thrombosis--formation or presence of a blood clot.

(b) Embolism--sudden obstruction of a blood vessel caused by the movement of a blood clot or other plug (for example, air).

(c) Hemorrhage--bleeding, especially profuse.

(d) Compression--pressing together of a blood vessel by an external force.

(e) Vasospasm--spasm or contraction of a blood vessel.

(2) Signs/symptoms of vascular disorders. The dysfunction may be major or minor, and may be temporary or permanent. Here are some early warning signs:

(a) Sudden, temporary weakness or numbness of the face, arm, and leg.

(b) Temporary difficulty with speech (aphasia).

(c) Brief dimness or loss of vision, especially in one eye. Double vision (diplopia).

(d) Brief dizziness or unsteadiness.

(e) Loss of memory.

(f) Change in personality or change in mental ability.

(3) Motor disability signs of vascular disorders.

(a) Hemiplegia--paralysis of the entire side of the body opposite to the injured side of the head.

(b) Hemiplesis--partial paralysis; muscle weakness.

(c) Paraplegia--paralysis of either both upper extremities or, more commonly, both lower extremities.

(d) Quadriplegia--upper and lower extremities are paralysized.

(e) Monoplegia--localized paralysis, a condition sometimes seen in trauma patients.

(4) Treatments for vascular disorders. Treatments may be short term or long term.

(a) Short-term treatment consists of treating the specific symptoms caused by CVA, maintaining the airway, and taking frequent vital signs.

(b) Long-term treatment includes the prevention of further loss of function with physical therapy and patient participation in a comprehensive rehabilitation program.