The pathology of a headache.

 

Case #1: For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last about an hour. James can be headache free for months at a time, but the attacks always return.
1. Describe the pathology of a headache.
2. Based on the different etiologies for headaches which of those fit this patients situation?
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
4. Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/ (Links to an external site.) as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.
Case #2: Mr. Smith is a new patient with a history of recent stroke approximately 3 months ago. He was hospitalized in another state, but you don’t have his records now. The patient’s wife is extremely anxious and worried about him because he hasn’t been “acting right”. She wants him checked out. She does not think he had hypertension but adds “he does not like to go to doctors.”
1. Regarding the patient’s available history, create a detailed plan of care for this patient.
2. In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024 (Links to an external site.). Based on these current guidelines what goals would you recommend for this patient to insure prevention of another brain ischemic event?

Sample Solution

The pathology of a headache

Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches often result from traction to or irritation of the meninges and blood vessels. The pain receptors may be stimulated by head trauma or tumors and cause headaches. Blood vessels spasms, dilated blood vessels, inflammation or infection of meninges and muscular tension can also stimulate pain receptors. Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscle of your head and neck (or some combination of these factors) can play a role in primary headaches. Some people may also carry genes that make them more likely develop such headaches.

nother element that further affiliates Viola and Olivia as a pair is the fact that they are both in mourning, Viola for her twin Sebastian, and Olivia who morns a dead brother and father. In this sense grief is something that creates a reflection within them. Shakespeare’s employment of the pair of Viola and Olivia also plays with sexual possibilities as we know that Olivia has fallen for another woman and a man (Antonio) falls in love with another man but then mistakes a character pretending to be a man for the man he is in love with (mistakes Viola for Sebastian). This concept could be Shakespeare’s way of suggesting that “gender identity is in the eye of the beholder – a man is someone recognised and treated as a man rather than someone with a set biological identity.”

Another distinct pair within Twelfth Night is Olivia and Orsino. Both of these characters are comparable as they both convey analogous traits, the first one being the passion and love that both characters express. Olivia seems besotted with Cesario (Viola) and even attempts to beg that she is worthy of love “Cesario, by the roses of the spring….Love sought is good, but given unsought better.” (3.1. 148-155). This clearly shows how bold Olivia’s emotions are and how readily she expresses them. However, this love is questioned when she marries Sebastian purely because he resembles Cesario. Orsino simple yet complex, just like the woman he is in love with and pursues, Olivia. Just like Olivia, Orsino also omits strong passionate feelings of love “If music be the food of love, play on; give me excess of it…” (I.1.1). This hyperbolic and profligate first line of the entire play forefronts the theme of love between this pair. However it also presents Orsino as self absorbed as it is not until the end of this loving speech that we realise it is about Olivia. It also suggests that Orsino loves the thought of love and all that it embodies, perhaps not the person themselves. Once again this is a similarity between Olivia and Orsino as they both appear to boldly express love that may in fact be rather empty and unreal. This could suggest that people of the higher social status are more in love with the idea of love and marriage rather than actually falling in love with the right people, higher social class may therefore result in this case in a bigger ego. Orsino’s over use of romantic clichés based on unrequited love “my desires, like fell and cruel hounds, E/re since pursue me” (I.1.2

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