Category: Uncategorized


The causes of cervicogenic headache are varied and typically depend on the problem in the structure of the neck. Various causes are described below:

  • Degenerative changes: The most common cause of cervicogenic headache is degenerative change (arthritis) in the neck (cervical spine). These are natural aging changes that cause bony spur formation, pressure on the nerves, and laxity/hardening of the ligaments.
  • Kyhposis (reversal of cervical curvature): The neck normally has a gentle C-shaped curve (lordosis) that allows the neck to curve slightly backwards. This normal position keeps the head in balance and reduces neck strain. As our discs dry out, they lose some of their height , resulting in straightening of the neck neck.  In some cases, the neck angles forward instead of backward. This causes greater strain on the muscles at the back of the neck, and results in occipital headache.
  • Whiplash: This is an injury that occurs from the head being “whipped” back/forth quickly. The mechanism of injury is from the head moving in a flexion/extension motion. The most common type of Whiplash injury is due to motor vehicle crash or contact sports injury (such as football or soccer). Headaches following whiplash are very common and have been reported in 80% of persons at 2 months following whiplash injury. Even 2 years after a whiplash injury, 20-25% of persons will still have headaches
  • Nerve compression: A common cause of nerve compression is degenerative disc disease, or arthritis in the neck. As the spine ages, and the discs lose their height, the small joints on the sides become more narrow. The nerves then have less room to travel through the joint, resulting in pressure on specific nerves. Another cause can be from a herniated disc in the neck that causes pressure on a specific nerve. Less commonly, nerve compression may be due to other causes such as tumors or abnormal fluid cavities in the spinal cord.

Tune in next week  to read about the risk factors for causing CERVICOGENIC HEADACHE.

Advertisements

Gluten is a protein compound that is found in most grains, including wheat, barley, and rye. Some form of gluten is also found in other foods such as white rice, oats and corn. Gluten is the substance that can be mixed with flour that helps give the texture and consistency of breads, crackers and some pasta. There can be small amounts of gluten in many other processed foods such as cereal, sauces, salad dressings, candy, processed meats, and condiments. Beer and many other alcoholic beverages also contain gluten. The best way of knowing if the food you eat contains gluten is to read the label carefully.

How do you know if you are gluten sensitive? One way of helping to determine if you are sensitive to gluten is to try a strict gluten-free diet for at least 3 months. As more people are becoming aware of gluten sensitivity, there are a wider variety of gluten-free products available. However, read all of the labels carefully, as some products may say “gluten free”, but can still contain a small amount. Be aware that many sauces, canned products and condiments contain small amounts of gluten. One easy way of avoiding gluten completely is to limit any processed food and stick with lean meat, fish, fruits, vegetables, nuts and berries (read more about the Paleo diet). While you avoid gluten, keep a food diary that includes your symptoms (or lack of symptoms). After 3 months, review the diary with your health care provider and discuss if your symptoms have improved.

SYMPTOMS of gluten intolerance include (but are not limited to):

  • Abdominal bloating/cramps/ pain
  • Diarrhea and/or constipation, nausea and vomiting
  • Fatigue
  • Weight  gain
  • Hair loss
  • Skin rash- called Dermatitis Herpetiformis- itching, blisters, redness
  • Depression and mood problems
  • Headaches
  • Joint pain/generalized muscle pain

 

What foods contain gluten?—most processed foods contain gluten unless stated otherwise on the label

  • Breads/cereals/pasta/tortillas
  • Candy
  • Ice cream
  • White rice
  • Pretzels, chips, pizza
  • many sauces, gravy, soy sauce and salad dressings
  • Beer and several alcoholic beverages
  • Cakes/cookies/pancakes
  • Processed meats (sausage, hot dogs, lunch meat, etc) and some cheese
  • Flavored milks (such as chocolate milk), and some soda such as root beer
  • Some additives in vitamins and supplements

The easiest way to avoid gluten is to avoid processed foods and stick to
lean meat, chicken, fish, fruits, vegetables, nuts and berries!

A Nurse Practitioner (or NP) is a registered professional nurse with advanced education and training who evaluates and treats patients as an independent health care provider.  The first formal Nurse Practitioner program was developed at the University of Colorado in 1965, and the educational programs have continued to grow throughout the United States and abroad. There are currently over 140,000 licensed NP’s practicing in the US.

All NP’s have a basic degree (Bachelor’s degree in Nursing) and a Masters Degree, which prepares them with specialized knowledge in the evaluation and treatment of patients in a wide variety of clinical settings. Some NP’s have earned a Doctor of Nursing (ND) or Doctor of Nursing Practice (DNP) degree which requires additional education of approximately 4 years.

All Nurse Practitioners must have certification from a national board, such as the American Nurses Credentialing Center. The license to practice as a NP is granted from the individual’s State Board of Nursing in which the NP practices. Some Nurse Practitioners practice in primary care, while others specialize in areas such as pediatrics, gerontology, oncology, women’s health, orthopaedics, neurosurgery, neurology, cardiology, psychiatry, etc.

Nurse Practitioners practice in a variety of settings, including rural clinics, offices, acute care hospitals, emergency department, urgent care, nursing homes, rehab facilities, schools and academic facilities.

Some of the services that NP’s provide include:

  • Evaluate and treat acute and chronic illnesses
  • Ordering and interpreting diagnostic tests
  • Evaluate and treat various specialty disorders
  • Prescribe medications
  • Prescribe treatments
  • Health education and health counseling

Choose a Nurse Practitioner for your health care provider!

Andrea (name changed) is in her 40’s and runs a busy household. For a few months, she had been waking up with a headache. Not daily at first, though recently they had become more frequent. The headache would resolve after being up a while, but recently it has lingered through the day.

She scheduled a visit with her family doctor.  There, she described a frontal, throbbing, and, at times, sharp headache. The past couple of weeks, she reported, episodes of numbness and weakness in the right hand and dizziness when changing positions.

A neurological examination revealed moderate difficulty walking with one foot in front of the other. Otherwise, the exam was normal. Her provider ordered an MRI of the brain which revealed the ventricles (spinal fluid spaces inside the brain) to be somewhat larger than normal – a condition called hydrocephalus (Figure 1). Something was blocking the flow of spinal fluid through the ventricles, but what could it be?

Figure 1 – Cross-section MRI showing enlargement of the ventricles (dark fluid filled spaces) in the center of the brain.

In the side view (sagittal) MRI, a tumor could be seen inside of the fourth ventricle, the fluid space between the brainstem and the cerebellum (Figure 2).  A cross section MRI scan (Figure 3), performed after she had received received intravenous contrast (“dye” material given through a vein), clearly outlined the tumor (Figure 3). It was blocking blocking cerebrospinal fluid (CSF) flow and enlarging the ventricle. This explained why the ventricles in the upper brain looked too big.

Figure 2 – Side view MRI of the brain showing the tumor between the brainstem and the cerebellum.

Figure 3 – Cross section view of the lower brain area. The tumor is easily after intravenous contrast was given.

Comment
There are various treatments for brain tumors. Some tumors are first diagnosed with a needle biopsy, while others may be treated with specialized radiation called radiosurgery. However, in many cases, surgery is required to remove the tumor. In Andrea’s case, the tumor was blocking CSF flow. If the blockage became worse, which was very likely since the tumor would keep growing, it could render her unconscious and jeopardize her life. A needle biopsy would not resolve the CSF blockage. 
 

Surgery
After careful discussions with her and her husband, she was readied for surgery. The plan was to reach the tumor through a cranial opening (craniotomy) at the back of the head.  Once the membrane surrounding the brain was exposed and opened, a path would be developed between the two halves of the lower cerebellum (called the cerebellar tonsils).  With gentle separation of the cerebellar tonsils, the lower part of the tumor came into view (Figure 4).

Figure 4 – Microphotograph during surgery showing the lower portion of the tumor between the cerebellar tonsils.

After a biopsy was obtained, the tumor was removed through microsurgery using the neurosurgical microscope, microsurgical instruments, and an ultrasonic aspirator – an instrument whose tip vibrates at ultrasonic frequencies and morselize (break-down) the cells. (This tool has replaced the laser that came into use in the 1980’s, although there are still a few applications for it today). Using the gentle action of the ultrasonic aspirator and microsurgical dissection, the tumor was steadily removed. Inspection of the floor of the fourth ventricle showed no residual tumor (Figure 5).

Figure 5 – View of the bottom of the fourth ventricle after the tumor was removed.

Andrea stayed in the hospital for … days and was then discharged home with her family. She steadily resumed her normal activities. Follow-up brain MRI scans have shown no residual tumor (Figure 6). Happily, she has recovered completely and is back to her busy life.

Figure 6 – MRI scan performed 7 months after surgery shows no evidence of tumor.

Comment
Tumors growing within the cerebral ventricles are rare in the adult population. In one study of 73 persons with intraventricular tumors, the types of tumor found included:

  • medulloblastoma
  • ependymoma
  • epidermoid
  • cystercircosis
  • astrocytoma
  • subependymoma

Other tumors found within the ventricles are a choroid plexus papillomas and meningiomas. A metastasis from a tumor elsewhere in the body can also develop within the ventricles.

The pathological examination of Andrea’s tumor revealed it to be a choroid plexus papilloma. Follow-up MRI scans within the first year following surgery have shown no tumor.  The chances of the tumor coming back from unseen cells buried within the tissues are about 10%. MRI scans will be performed on a regular basis for a few years.

REFERENCE

Intraventricular mass lesions.

Morrison G, Sobel DF, Kelley WM, Norman D.

Radiology. 1984 Nov;153(2):435-42.

http://preview.ncbi.nlm.nih.gov/pubmed/6333046