Ischialgia Etiology and Clinical Manifestations

        Ischialgia is pain felt along the leg. Judging from the sense of the word, then ischialgia is pain felt along N.ischiadicus. So ischialgia defined as pain felt along the nerve and subsequent ischiadicus along the legs. Ischialgia is a condition where the nerves Ischiadicus, which innervate butt to foot pinched area, in that case, which is pinched nerves Ischiadicus right side. This can happen due to some disease processes such as physical trauma, chemical, and electrical, infections, metabolic problems, and autoimmune. Ischialgia increase in frequency along with the many activities undertaken.

Treatment and Therapy of Cluster Headache

        Medical Treatment and Therapy of the cluster headache can be divided into the treatment of acute attacks, and preventive medicine, which aims to suppress the attack. Acute and preventive treatment started simultaneously when the initial period of the cluster. Latest surgical treatment options and neuro stimulation has replaced detrimental treatment approaches.

Diagnosis of Cluster Headache

      Cluster headache diagnosis using the criteria by the International Headache Society ( IHS ) is as follows :
a. At least 5 attacks with such criteria under
b . Severe or very severe unilateral orbital, supraorbital and or temporal pain for 15-180 minutes if untreated .

Pathophysiology of Cluster Headache

    The pathophysiology of cluster headache is still remains unclear. However, there are several theories regarding the pathophysiology of Cluster headache. One theory is that the focus of the pathophysiology of cluster headache is located in the carotid artery which stimulates intracavernous pericarotis plexus. 

Cluster Headache

    Synonyms : Eritroprocephalgia Bing, ciliary neuralgia/migrenous (Harris), Eitromelalgia head, Horton headache, histaminic cephalgia, petrosal neuralgia (Gardner), spenopalatin neuralgia, neuralgia Vidian and Sluders, hemicrania neuralgiformis periodically .

Medical Treatment and Therapy for Tension Headache

      The principle of treatment is psychologic approach (psychotherapy), physiological (relaxation) and pharmacological (analgesic, sedative and minor transquilizers). In practice, it needs an adequate explanation of the background of the pain that the patient understands, about the issues that are less or not realized.

Clinical Manifestations of Tension Headache

        The symptoms that can occur in tension headache are: a headache that felt like a heavy head, stiff as tied rope wrapped around head, and pressed tight. Sometimes with throbbing headache. If prolonged, on palpation can be found swollen, hard and tenderness area. Can also be accompanied by symptoms are: nausea, vomiting, vertigo, fatigue, difficulty to sleep, nightmares, frequent waking early in the morning and fall asleep, hyperventilation, abdominal bloating, sadly, the loss of the will to learn or work, anorexia and other depressive complaints. Pain can also be felt as a tense feeling the pinch in the head and pain located in the area occipitocervicale.

Pathophysiology of Tension Headache

      Tension Headache pathophysiology is still not clearly known. In some of the literature and research results mentioned several circumstances relating to the occurrence of  Tension Headache as follows:
(1) central nervous system dysfunction that is more involved than the peripheral nervous system dysfunction of the peripheral nervous system which leads to more ETTH, whereas central nervous system dysfunction leads to CTTH (Chronic Tension Type Headache) ,

Tension Headache

       Type Tension headache or tension-type headache is defined as a sensation of heaviness or pressure that settled, on both sides of the head arising episodic and associated with stress, but it can be repeated almost every day without any psychological factors. The pain arises due to continued contraction of the muscles of the head and neck is m. splenius capitis, m. temporalis, m.maseter, m. sternocleidomastoid, m. trapezius, m. posterior cervical, and m. levator scapula.

Medical Treatment and Therapy for Migraine

Treatment and Therapy Migraine

Migraine Treatment Targets
Migraine treatment and therapy goals depends on length and intensity of pain, symptoms comorbidities, degree of disability and the start of treatment response and may also be found in other diseases such as epilepsy, anxiety, stroke, myocardial infarction. Because it must be wary of the medicine. When there are symptoms of nausea/vomiting, the medicine is given rectally, nasal, subcutaneous or intravenous.

Clinical Manifestations of Migraine

Migraine without aura
The attack began with a throbbing headache on one side with a duration of 4-72 hours. headache worsens with physical activity and followed by nausea and, photophobia or phonophobia.

Diagnosis of Migraine

A. Migraine without Aura
     Previous term: Common migraine, hemicrania simplex.
     Description:
Recurrent headache attacks with manifestation for 4-72 hours.  Characteristics unilateral head pain, throbbing, moderate intensity or  severe, worsen with routine physical activity and followed with nausea and photophobia and phonophobia or.

Pathophysiology of Migraine

Vascular Theory 

       Intracranial vasoconstriction in the outer cortex plays a role in the occurrence of migraine with aura. This opinion is reinforced by the presence of headache accompanied with the same heart rate. Blood vessels constrict primarily located in the brain due to activation of peripheral nociceptive nerve locals. This theory was initiated above observation that the extracranial veins that will undergo vasodilation palpable heartbeat. This vasodilation will stimulate people to experience headaches. In such conditions, vasoconstrictor drugs, such as ergotamine will reduce headaches, while vasodilators such as nitroglycerin will worsen headaches.

Migraine

Migraine

 Definition of Migraine
      According to the International Headache Society (IHS) migraine is a vascular headache with recurrent pain attacks that lasts 4-72 hours. The pain is usually one sided (unilateral), its throbbing, pain is moderate to severe intensity, aggravated by activity, and can be accompanied by nausea and or vomiting, photophobia and phonophobia.

Headache

       Headache is often referred to as headache, dizziness and others, is pain or an unpleasant taste in the whole area of ​​the head to the lower limit of the chin up to the area behind the head ( occipital area and some areas nape ).

Medical Treatment and Therapy of Benign Paroxysmal Positional Vertigo

       Management of BPPV include observation, medication to suppress vestibular function (vestibulosuppressan), canalith repositioning, and surgery. Primary election governance is observed, Because BPPV can own resolution in weekly or monthly. Therefore, most experts recommend that only observation. However, during the observation time of patients still suffer from vertigo. As a result, patients are faced with the possibility of falling when vertigo blaze while he was on the move.

Clinical Manifestations and Diagnosis of BPPV

Clinical Symptoms 

      BPPV occurs suddenly. Most patients are aware of the time they wake up, when to change position from lying to sitting. Patients feel dizzy spinning gradually diminished and disappeared. There is a lag between changes in head position with the onset of feeling dizzy spin. In general, feeling dizzy spinning arise very strong in the beginning and disappears after 30 seconds while its recurrent attacks become lighter. These symptoms are felt for days to months.

Pathophysiology of Benign Paroxysmal Positional Vertigo (BPPV)

       In the inner ear there are three semicircular canals. Three semicircular canals are located in areas that are mutually perpendicular to each other. At the base of each Semicircular canals, there is a widened portion which called ampula. In ampula there cupula, is a tool to detect the movement of fluid in semicircular canals as result of head movement. For example, when someone turned his head to the right, the fluid in the right  canal semicircularis will be left, so Cupula will deflecting towards ampula. Deflection is translated in a signal goes to the brain so that the sensation arises head turned to the right. With the availability of particles or debris in Semicircular canals, will reduce or even create cupula deflection towards the head instead of the actual direction of motion. It gives a signal that is not in accordance with the direction of head movement, so that arise in the form of vertigo sensation.

Benign Paroxysmal Positional Vertigo

      Vertigo is a complaint which often encountered in practice, is often described as a sense of spinning, feeling shaky, unstable (giddiness, unsteadiness), or dizziness; description of the complaint is important to know in order not to be confused with headache or cephalalgia, especially because among the laity, the second term (dizziness and headache) are often used interchangeably.

Medical Treatment and Therapy of Vertigo

      Because the causes of vertigo are varied, while patients often feel very annoyed with vertigo symptoms, often using symptomatic treatment. The duration of treatment are varied. Most cases of therapy can be stopped after a few weeks and here are some commonly used classes of drugs: