Neuro & Ortho Clinic

Headaches and migraines can vary drastically depending on their duration, specific symptoms and the person they are affecting. The more you know about your specific type of headache or migraine, the better prepared you will be to treat them—and possibly even prevent them. The two types of migraine are- 

1. Migraine without aura: The majority of migraine sufferers have Migraine without Aura. 
2. Migraine with aura: Migraine with Aura refers to a range of neurological disturbances that occur before the headache begins, usually lasting about 20-60 minutes.

Symptoms of migraine vary and also depend on the type of migraine. A migraine has four stages: prodrome, aura, headache and postdrome. But it is not necessary that all the migraine sufferers experience all the four stages.

Prodrome: The signs of this begin to appear a day or two days before the headache starts. The signs include depression, constipation, food cravings, irritability, uncontrollable yawning, neck stiffness and hyperactivity.

Migraine Aura: Auras are a range of symptoms of the central nervous system. These might occur much before or during the migraine, but most people get a migraine without an aura. Auras usually begin gradually and increase in intensity. They last for an hour or even longer and are 

• Visual: Seeing bright spots, various shapes, experiencing vision loss, and flashes of light
• Sensory: Present in the form of touch sensations like feeling of pins and needles in the arms and legs
• Motor: Usually related with the movement problems like the limb weakness
• Verbal: It is related with the speech problems

Headache: In case of a migraine attack one might experience:

• Pain on both sides or one side of the head
• Pain is throbbing in nature
• Vomiting and nausea
• Sensitivity to smells, sound and light
• Vision is blurred
• Fainting and lightheadedness

Postdrome: This is the final phase of the migraine. During this phase one might feel fatigued, though some people feel euphoric.

Red flags that the patient may be having underlying serious disorder not migraine

1. Onset of headaches >50 years 
2. Thunderclap headache - subarachnoid haemorrhage 
3. Neurological symptoms or signs 
4. Meningism 
5. Immunosuppression or malignancy 
6. Red eye and haloes around lights - acute angle closure glaucoma 
7. Worsening symptoms 
8. Symptoms of temporal arteritis

These patients require CT scan / MRI or CSF examination. Most Migraine patients do not need these tests. 

Diagnosis of Migraine: Usually migraines go undiagnosed and thus are untreated. In case you experience the symptoms regularly then talk to the doctor, who evaluates the symptoms and can start a treatment. You can also be referred to a neurologist who is trained to treat the migraines and other conditions. During the appointment the neurologist usually asks about the family history of headaches and migraines along with your symptoms and medical history.

The doctor might advise for some tests like:

1. Blood Tests: These reveal problems with the blood vessel like an infection in the spinal cord and brain.
2. CT scan: Used to diagnose the infections, tumors, brain damage, and bleeding that cause the migraines.
3. MRI: This helps to diagnose the tumors bleeding infections, neurological conditions, and strokes.
4. Lumbar Puncture: For analyzing infections and neurological damages. In lumbar puncture a thin needle is inserted between the two vertebrae to remove a sample of the cerebrospinal fluid for analysis.

Treatments

Migraine treatments can help stop symptoms and prevent future attacks.

Many medications have been designed to treat migraines. Some drugs often used to treat other conditions also may help relieve or prevent migraines. Medications used to combat migraines fall into two broad categories:

• Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.
• Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.

Your treatment strategy depends on the frequency and severity of your headaches, the degree of disability your headaches cause, and your other medical conditions.

Some medications aren't recommended if you're pregnant or breast-feeding. Some medications aren't given to children. Your doctor can help find the right medication for you.

Alzheimer's Disease is a neurological problem that is characterised by a cognitive decline and memory loss. It is a type of neurodegenerative dementia. The symptoms of Alzheimer's Disease include not being able to absorb and retain new information, lack of reasoning and judging, not being able to take on complex tasks, impaired visuospatial abilities, problems in reading, writing and speech, among many others. If a person has at least two of these symptoms in a debilitating manner, then the diagnosis can be made in favour of Alzheimer's Disease.

The main causes of Alzheimer's are shrinkage of the brain size and death of the brain cells. The immune system is also said to trigger this neurodegenerative disease.

Let us find out what medical science has found so far:

1. Connections

Many a times, in Alzheimer's disease, the memory and behaviour of the person changes because the brain is unable to make proper neural connections which can lead to memory loss of how a person behaved and the elements that formed the basis of the patient's cognition. Apparently, the immune system behaves in the same way within the brain and blocks the connection. This happens because there is constant communication between the brain and immune system along neurological lines, which is where the disease first emanates.

2. Inflammation

The brain is prone to inflammation or swelling that is not the normal kind. This inflammation happens as a result of the activation of the infection fighting neurotransmitters and the chemical changes that happen in the brain when an infection strikes. The inflammation usually happens in the plaques or clumps which the brain tries to protect. These clumps are made up of a protein called Amyloid. The immune system is responsible for creating this inflammation in the brain of the patient.

3. Pattern Recognition Receptors

Many of these receptors work in different manners and cooperate with each other to create a response in the brain. These PRRs can be found in the brain plaques, and they develop the signs of danger which further fuels the inflammation in the brain as a matter of protection.

4. Activation of Cells Linked with the Immune System

When the PRRs begin to respond, it basically activates the immune system and the cells of the same. This is the basic reaction that causes the changes in brain which then leads to the attachment of the protein to the tissue that is diseased, in which case Alzheimer's Disease starts. The inflammation that we had spoken about earlier basically happens in the nervous tissue.

It is important to recognise and act on the initial signs of Alzheimer's Disease before it progresses beyond one's control.

Regardless of whether the cause is a tumor, trauma, stroke or any other illness, any injury which inflicts damage on your brain cells is considered to be a brain damage. 

There are two types of brain damage, both of which interfere with the standard functioning of the brain. 
They are:

1. Acquired brain injury (ABI): Either resulting from a tumor or a neurological illness, for instance a stroke, this type of brain injury originates from the cellular level and is commonly linked with brain pressure.
2. Traumatic brain injury (TBI): It results from any damage imparted to the skull usually from an external and physical force like a blow to the head or a head accident, which in turn damages the brain.

How severe the brain damage is depends largely on the type of brain injury. Mild brain injuries are temporary, causing headaches, memory lapses, nausea and confusion. On the other hand, severe brain injuries cause cognitive, physical and behavioral impairments which are often life-changing and permanent.

Causes:
Acquired brain injuries may be caused by:

1. Poisoning
2. Being exposed to toxic substances
3. Choking, strangulation or drowning
4. Heart attacks
5. Infections
6. Stroke
7. Tumors
8. Neurological illnesses
9. Aneurysms
10. Illegal drug abuse

Traumatic brain injuries are usually caused by:

1. Car accidents
2. Sports injuries
3. Physical violence
4. Head blows
5. Falls and other mishaps

Symptoms:
Whether acquired or traumatic, symptoms of brain damage can be classified under four major groups:

1.  Cognitive symptoms generally include

• Having a hard time processing information or expressing thoughts
• Difficulty in understanding others or abstract concepts
• Indecisiveness
• Memory loss
• Short attention spans

2.  Physical symptoms generally include

• Excessive physical fatigue
• Extreme mental fatigue
• Persistent and frequent migraines or headaches
• Paralysis
• Seizures
• Tremors
• Sleep disorders
• Light sensitivity
• Loss of consciousness
• Slurred speech

3.  Perceptual symptoms generally include

• Spatial disorientation
• Smell and taste disorders
• Heightened pain sensitivity
• Changes in hearing, seeing, or touch sensations
• Unable to perceive time
• Balance problems

4.  Emotional or behavioral symptoms generally include

• Decreased stress tolerance
• Heightened or flattened reactions or emotions
• Aggressiveness
• Sluggishness
• Impatience and irritability
• Self-denial

Acoustic neuromas are tumors that develop on the nerves connecting the ear to the brain. Being non-cancerous in nature, they do not spread to other parts of the body. However, they are characterized by symptoms such as gradual or sudden hearing loss, more pronounced with either of the ears, a ringing sensation in the affected ear, weakness, facial numbness and dizziness.

Causes:

Acoustic neuroma can be of two types: one is sporadic in nature and the other is associated with a condition known as neurofibromatosis type II (NF2). NF2 is basically an inherited disorder identified by benign growth in the nervous system. NF2 being a rare disorder, makes the sporadic type the dominant one. Although the causes behind this type of neuroma are still unknown, long term exposure to radiations, especially around the neck and the head, could be one of the most important triggering factors.

Treatments:

Once the diagnosis is done, treatments for acoustic neuroma depend on the growth and size of the tumor.

1. Diagnosis with the help of monitoring: Small tumors exhibiting no such symptom or slow signs of growth need to be monitored with the use of hearing tests and regular imaging. In case, the MRI scans are able to trace any sort of development on the part of the tumor or if the tumor poses subsequent difficulties, opting for treatment becomes the need of the hour.

2. Stereotactic Radiosurgery: Also known as Gamma Knife, radiosurgery is a treatment method wherein controlled radiations are used to treat tumors, thus doing away with the need of making any incision.

3. Surgical Removal: Surgery performed under general anesthesia is directed towards removing the tumor; that helps to preserve the facial nerve and thus inhibit facial paralysis and hearing loss. The tumor is usually removed either through the ear or through the skull.