Neuro | Headache | Dr. Majed Habahbeh

Added: 2026-05-22

[00:00:03]Just to be safe, you do n't need to record the audio in case you lose something.

[00:00:24]Thank you, dear students.

[00:00:27]Yes, we'll be giving you these lectures twice, one from me and one from Dr. Iman. These were given in previous years by our colleagues, Dr. Yaqoub and Dr. Majd, so they aren't our lectures. But we'll tell you what the important things are. I'll talk to you about the lecture on cerebral hedactyly. It's a big topic and a very common presentation in neurology, in clinics, in ER, everywhere. We talked about it a little in Emergency Medicine, but today we'll talk more about chronic hedactyly. Yes, the slides are available for anyone who wants to see them, but for exam purposes. Yes, I'll focus on a few points. Primary hedactyly disorders, which are like migraines and cluster hedactyly, etc., are the most common types of hedactyly in clinics, etc. But Alexandrian hedactyly disorders are also present. They are important, even though they are not common, and they are the cause of many patients who have secondary hemorrhages, etc. Let's go through the basic parts.

[00:01:59]Of course, patients can have multiple hemorrhages and have more than one type of hemorrhage. They might have migraines, they might have medication, etc. Patients with migraines can develop secondary hemorrhages. There are other types of hemorrhages besides migraines. So, the history is very important in patients with hemorrhages. You need to know if these patients have typical migraines or not, and if there are any changes in the pattern of the hemorrhage, for example, secondarily, meaning a thorough investigation.

[00:02:34]This is one of the things that the slides, the busier slides, mean. What do you take as history from a patient with hemorrhages? Of course, they have two hemorrhages in terms of host, progression, deviation, attics, or not attics, etc. Location, quality, frequency, C. All these things that you are used to need to take. There are also more specific things for hedigms like analgesic use, caffeine use, medications, social family, and sleep history.

[00:03:14]These summarize the important points in the history.

[00:03:18]Now, when do we suspect a patient has secondary hedigms, not primary ones like migraine or tension hedigms, etc.? These features include: if the patient has progressive hedigms, especially acute hedigms and fever, as we mentioned, rare cases, this is what we need to know.

[00:03:44]If there's something new, if there's a catarrh, if there's any recent trauma, if there's oxidation, stenosis, or alpha-1, or sneezing, etc., or if there's a change in the patient's profile, line or standin, if there's systemic strokes or any type of complication, acute glaucoma, or if the patient has, as we said, migraine or standin but there's a significant change in the pattern and character of those who are experiencing new symptoms, then they need investigation.

[00:04:31]Also, patients who... They are usually older and their head deformities start later in life, or they have a history of specific immunosuppressive drugs or other immunocompromised conditions, etc. These patients, of course, need work.

[00:04:52]We also mentioned head deformities; it might have been mentioned earlier. So, a patient with these conditions needs a general assessment in addition to the history we discussed. They need a physical examination.

[00:05:08]Sometimes the problem is very high blood pressure, and you have two [unclear], meaning a diagnosis, as we said, of blood pressure and temperature.

[00:05:24]You need to see if there are any developmental issues, to make sure there's nothing wrong with the cardiovascular system, etc. And what's very important is the ophthalmoscopic assessment. Now, these patients are usually referred to the ophthalmologists, and the ophthalmologists widen the eyes and examine the ophthalmology using their equipment and give us a report on whether there is an optical disc herniation or not.

[00:05:57]Physical assessment, in terms of neurology, is the same as physical assessment. You check if there are any vocal defects.

[00:06:08]This table is like an introduction to the topic of migraine, tension, and clusters. The same information will be repeated in slides. So let's go with this slide. This slide also compares migraine, tension, headache, and clusters. Headaches are a type of cluster, and these are the ones that cause migraine and headaches.

[00:06:49]These always come side-to-side. You see an area of ​​the brain and they differ from each other.

[00:07:01]How do they differ from migraine? This is just a simple question. So you need to look at this table and study it, especially to differentiate between migraine and clusters.

[00:07:31]Temporal arteries, which are part of giant cell arteries, i.e., large, medium, and visceral arteries.

[00:07:39]This headache usually comes in the temporal region. It occurs in older adults, those over 60 or 55, and there are systemic symptoms and gynecological pain. The temporal artery is abnormal, it's painful and tender, and you don't feel the pain easily. Usually, the inflammatory markers, ESR and C-reactive protein, are high.

[00:08:10]Medication overuse occurs, especially in patients with migraines if they use any type of angina. The more they have antacids, the more they use antacids, so they develop migraines. I call this medication overuse. The milder the migraine, the more chronic the migraine, and the more antacids they use.

[00:08:39]Skip this. These are the types of secondary hemostatics that can occur if the patient is acute, but the patient usually rests, sleeps a little, takes two paracetamol tablets or one non-steroidal anti- inflammatory tablet, and things get better. It's bilateral, not unilateral, and it feels like pressure on the top of the head. There aren't the usual symptoms we see in migraines like photophobia, phonophobia, fumtinitis, nosia, etc., but there might be some tenderness in the neck muscles and shoulders— head tension and associated muscle tension—meaning tension in the back of the head and shoulders. We don't usually see this often in clinics because the action is n't the same as with migraines. The treatment, as we mentioned, is either nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol.

[00:10:01]If we want to give something to relieve the patient, we might use amitriptyline, which is a tricyclic antidepressant.

[00:10:11]Sometimes we go for different medications that work differently, like mirtazapine ( also an antidepressant) and venlafaxine (an antidepressant that works on serotonin and norepinephrine, etc.). We sometimes resort to these if the patient doesn't respond to amitriptyline or other similar medications. Feedback and this is for migraine, meaning here is the slide, this is the diagnostic criteria for migraine, the International Headache Society, and it's important that we're here mostly talking about migraine and that migraine organoscopic criteria, meaning they're slightly different, but this is the main one in terms of pain, meaning the number of hours of pain, the duration of pain is from 4 to 72 hours, unless the patient takes medication. After an hour, the patient knows that the headache started, so they take medication, and the pain goes away after two or three hours. But this is my migraine, meaning it's not a problem now that they've taken medication, but it could be on for four days.

[00:11:42]Sometimes migraine lasts for many days, and this is a condition we call status migraine, but it's not required of you.

[00:11:54]Its treatment is different, and the headache has characteristics, meaning it has a specific location.

[00:12:00]Of course, not all migraines are the same; there are about 30% of migraines come with aura. The quality of the migraine is very important, of course. Aura is generally considered to be at least by-bye movement. There are also known symptoms.

[00:12:20]Generally, the characteristic of migraine is that migraine with aura is less than migraine without aura. Aura can be visual, like flashing lights or partial vision loss. The aura can be sensory or type 1 aura, but what distinguishes aura is that it doesn't last long. It usually lasts 15 minutes, as we mentioned, or less. Now, forget about that information. This is the first line of treatment. It doesn't apply to patients with migraine. We don't use terabine.

[00:13:27]These are for the main type of migraine. We can give them aura, we can give them sebum, or tetanus, or something else depending on the patient's condition. If it's quinine or omeprazole, then this attack means... because we don't like to give opitus. Patients with migraine with aura or omeprazole are given with... Analgesic gives antibiotics like metoclopramide or other antiemetics that can be given, or in another way depending on the patient's condition.

[00:14:15]Prophylaxis is used if the ataxia is frequent or enters the life of the patient. The prophylactic treatment is used, and the available options are propranolol, toparamet, and amitriptyline. We can sometimes use triptans if the ataxia occurs around the menstrual period.

[00:14:38]In neo-monoglobulin infections, there are also antibodies, especially for example, in Jordan, we currently have erenumab, but there are three others.

[00:14:48]These work on CGRP. The CGRP inhibitor is different from migraine. It always occurs unilaterally and always on the same side.

[00:15:03]We said that about 70% of migraine cases are unilateral, and unilateral cases in migraine sometimes occur on the right and sometimes on the left, so it doesn't necessarily occur on the left. On the same side as with clumping, the same side and more common in males, unlike migraine, which is more common in females. So the drainage is different, and the table I showed you is in the information. A short-term drainage doesn't last more than three hours. By definition, it usually lasts an hour or so and goes away, but it's very, very short and can recur two, three, or four times a day, depending on the case. It's very short, as we said, and the patient is very restless, unlike with migraine.

[00:15:54]The patient prefers not to move, to sleep, to turn off the light and sleep. A cluster patient finds it very difficult to go to sleep in the shade. Very restless and induced, and it comes in clusters. The cluster persists and then goes away, only to return after a year or two. Attacks occur in autonomic phases. Here, there is a thrombus, just like horns, and the nose and throat become blocked, etc. The thing is that the first check is primary, but in a later case, there is an underline, leg, etc. In the case of a cluster headache, the patient is given an embolist, meaning acute treatment with oxygen. This is practically the only headache among all types of headaches where the response rate is very high, around 80 or 90%. Alternatively, you can use something like Sumatriptan (suppositories).

[00:17:18]If you need prophylaxis, you can use Verapamil or Topira, or you can give some steroids.

[00:17:26]This is what we said, cluster headache. It's a type of autonomic nervous system disorder.

[00:17:32]Other types include stenosis, heminucleosis ( not the same as secondary headache), and other types. These have many causes, including things related to blood pressure, tumors, and urinary tract infections.

[00:17:57]You can talk about Vasker, anthracrimation, subconjunctivitis, anthracrimation, spasticity, and so on. All of these are causes of acute headaches and secondary headaches. Of course, we won't talk about them much here because they are present in the Other slides in Attrition, and all these things we talked about in Emergency, Spiral, Fins, The Brainor, Secondary, and so on.

[00:18:26]We think about it, especially in women at the end of pregnancy or the beginning of postpartum, or in women who are on their way, or generally in patients who have it. And this is MR Venoram, meaning evidence.

[00:18:54]We talked about genital artery disease a little while ago, and this happens more in older people. The fear is always that genital artery disease can cause blindness, meaning artery disease, and it causes a balance of persons.

[00:19:12]I did the ESR protein, and it came back high, and he has some pain in the artery area, and so on. You start anesthesia later because if you wait to do anesthesia, the patient might become blind, and you haven't reached it yet.

[00:19:34]In general, infection and infection of the CNS, we won't talk about them now, we'll talk about them in other lectures, of course. Importantly, it is diagnosed by genital biomarkers, whether primary or secondary. I do hacker- cans. So, when someone wakes up, for example, etc., rheumatic causes, we wo n't talk about them. Head Injury. Now, intracranial pressure disorders are of two types: either intracranial hypertension, which I call cryptosis, or what happens in long-term females. I think we'll talk about that in other lectures, but these come with high intracranial pressure and they have papilledema, but there's nothing in the brain. I mean, these are because they also have cerebral palsy.

[00:21:09]These, besides losing weight, they lose weight if they overdo it.

[00:21:16]This is acetazolamide.

[00:21:18]So, patients need this drug. Usually, the CSF opening pressure is high, of course, and the CSF analysis is normal. In cases of intracranial hypotension, it's the opposite; there's CSF hypotension. Then, the CSF is normal.

[00:21:36]What are the symptoms? Sponsoredly, or after a period of time, there's a lot of fluid in the CSF. We do intracranial hypotension, and patients come complaining of this a lot. So, this shows us that the fluid is in the blood, and this is treated with blood thinning.

[00:22:08]We take blood from the patient's blood and inject it.

[00:22:18]But this means that in cases where the fluid usually stops a little, and medication, as we talked about, in medication causes this. There are some things that are plain and some more serious, like contraindications when you do cerebral venous insufficiency.

[00:22:48]Patients who drink a lot of coffee may have an increased risk of migraine. Caffeine exposure also causes them to have caffeine, and the peak is if they suddenly stop caffeine, like when someone fasts during Ramadan. There are specific causes here.

[00:23:00]Sciences specific causes for frontal insufficiency. Usually, the ENT is more covered, and in the thrombosis, etc. And it comes to be talk to Finally, this is a speech type.

[00:23:53]Usually, if the features are present in the patient, you should focus on them. These features are important. What are the things that make us think that the neurological translations are confused, or something related to brain or brain? Of course, this is the lecture. May God grant you well-being.