Headache

Headache is of three types:

1. Cluster Headache
2. Tension type headache
3. Migraine headache

Characteristics of Cluster Headache:
1. Males are more often attacked by this than females.
2. It usually occurs during sleep.
3. It is unilateral and its location is behind and around eyes.
4. It is excruciating, sharp and steady.
5. Its duration is from 10 minutes to 3 hours.
6. It can cause unilateral sweating, facial flushing, nasal congestion and lacrimation.

Characteristics of Tension Type headache:
1. It is more often in females than in males.
2. It occurs usually under stress.
3. It is bilateral in band around head.
4. It is dull and persistant.
5. It occurs in episodes from 30 minutes to 7 days and.
6. It can cause mild intolerance to light and noise.

Tension type headaches respond very well to over the counter analgesics.

Characteristics of Migraine:
1. It occurs in females more often than males.
2. It is variable and can start any time.
3. It is unilateral.
4. The pain caused by this is pulsating and throbbing.
5. It can last, in episodes, from 2 to 72 hours.
6. It can cause visual auras, sensitivity to light and sound, pale facial appearance, nausea and vomiting.

Types of Migraine headache:

Note: Migraine and cluster headaches are the types of “Vascular headaches”, whereas Tension headache is the most common form of “Myogenic / Muscular headache”.

Biologic basis of Migraine Headache:
Hypoperfusion occurs in Migraine with aura. Migranious aura is due to abnormally high release of serotonin from platelets.

Firstly: There is a spreading depression of neuronal activity.
Secondly: Reduced blood flow in the most posterior part of the cerebral hemisphere.
Thirdly: This hypoperfusion spreads on the surface of the cortex.

These hypoperfused regions show an abnormal response to changes in arterial pCO2 (this is alteration of function) and there is an increase in the amplitude of temporal artery pulsations.

Hypoperfused state remains during aura and headache phase and after that hyperperfused state comes.

No hypoperfusion occurs in Migraine without aura.

Pain in migraine headaches is considered to be due to extra cranial and intracranial arterial dilation that results in release of neuro-active molecules such as substance P.

In woman, whose headache is related to menstrual cycle, migraine is due to
1. Falling levels of estrogen.
2. Elevated levels of prostaglandin E1.

Phases in Migraine headache:
There are three phases:
1. Asymptomatic phase: No symptoms or pathologic features are found between the previous attack and until next attack.
2. Prodromal Phase: It starts with visual disturbances. In this phase there is vasoconstriction of arteries and release of serotonin.
3. Headache Phase: Here pain starts along with nausea and vomiting. Here, cerebral vasodilation occurs and due to release of serotonin, there is a large amount of serotonin.

Treatment of Migraine:

Prophylaxis of Migraine headache:
When there is recurrence of migraine headache two or more times in a month. Drugs on prophylactic bases can be taken such as β-blockers (propranolol, nadolol) can be taken. Some ergot alkaloids like Methysergide are also effective.

Acute migraine headache:
When the first symptoms of migraine headache started, following medicines are effective to prevent the near future headache:
1. Sumatriptan
2. Ergotamine
3. Dihydroergotamine

Cough

It is the process of releasing air through the windpipe and mouth in a sudden noisy manner. Cough is initiated when there is a mechanical or chemical irritation to bronchi and trachea or by pressure from adjacent structures. Larynx and carina are especially sensitive to chemical stimuli such as SO₂ gas or chlorine gas.

Useful aspects of cough:
It is a physiological mechanism which:
1. Clears the respiratory pathways from foreign materials and extra secretions
2. May help to prevent sudden collapse of lungs.

Tuberculosis

Symptoms of tuberculosis:


Early symptoms:
Usually no symptoms develop but sometimes influenza is present.

Symptoms in second stage:
1. Low fever
2. Weight loss
3. Chronic fatigue
4. Heavy sweating especially at night

Later stages:
1. Cough with sputum that becomes progressively bloody, yellow, thick or grey
2. Chest pain
3. Shortness of breath
4. Reddish or cloudy urine

Hypertension

It is an arterial disease accompanied by abnormally high blood pressure. It is also called as “Hyperpiesis” or “Hyperpiesia”.

Systolic pressure:

Persistent systolic blood pressure at about 140 mmHg or greater

Diastolic pressure:
Persistent diastolic blood pressure at about 90 mmHg to 110 mmHg

After effects of hypertension:
1. Congestive cardiac failure
2. Myocardial infarction
3. Renal damage
4. Other cerebrovascular disorders.

Vomiting

It is the forcible throwing of contents of stomach up through mouth as a result of involuntary spasms of the muscles of the stomach. It is also called emesis.
The chemoreceptor trigger zone as well as vomiting center of the medulla oblongata is involved in the emesis.

Following illustration is helpful in this context.

Causes of vomiting:

Vomiting may have from one of the following causes:

1. Motion sickness
2. Intestinal obstruction
3. Disease or disorder of the inner ear
4. Some kind of injury to the head
5. Appendicitis
6. Adverse effects or direct effects of certain drugs
7. Pregnancy
8. Renal failure

After effects of vomiting:
In severe cases vomiting may result in dehydration, malnutrition, or rupturing of the esophageal wall.

Therapeutic strategies:
Its treatment is directly towards the cause or origin of vomiting. It is beneficial to drink a lot of clear water or any other fluids so that the chances of dehydration will not be there.

On the other hand, medicines can also be used.

Nausea

It is the disturbance of the stomach which accompanies the feeling to vomit.

Nausea directly is caused from irritation of the nerve endings present in the stomach or duodenum, which stimulates nausea and vomiting control centers present in the brain.

Causes of nausea:
The most common causes of nausea are
1. Indigestion:
The nausea caused by indigestion is due to eating too rapidly or emotional stress.

2. Motion sickness:
This is caused by the disturbance in the balance organs of the inner ear i.e. semicircular canals of the ear. The messages for disturbance go to the lower brain.

3. Pregnancy:

Hemostasis

It refers to the spontaneous arrest of the flow of blood from a vessel which is damaged.
Hemostatic response:
Vasospasm:
Vessels become spasmodic suddenly after the vessel is damaged.

Formation of platelet plug:
After the endothelium is damaged the platelets get stick to collagen as well as to each other resulting in the formation of platelet plug.

Several factors are released by platelets such as ADP, TXA2, and serotonin which results in further aggregation of platelets as well as vasoconstriction.

Next in the process, aggregated plug of platelets make it possible for the platelet factor 3 availability leading to the sequence of coagulation process further to take place.

Fibrin reinforcement of platelet plug:
A series of reactions are activated after the stimulation of coagulation system. Coagulation system works through two interrelated processes – Intrinsic and extrinsic processes.

Extrinsic pathway:
Extrinsic denotes something that comes from outside. Extrinsic pathway denotes a series of reactions which is activated by tissue factor that comes from outside of blood.

It activates Factor VII by a tissue factor i.e. thromboplastin

Intrinsic Pathway:
Intrinsic denotes something which is found in body part. In the intrinsic pathway proteins for the activation of the process of blood coagulation are present in the blood.
Intrinsic process activates Factor XII.
Both of these processes mainly activate the formation of thrombin.
And in the final result fibrin molecules are released which are helpful for giving firmness to the platelet plug.

Angina

It refers to a severe type of pain from any cause usually angina pectoris is considered.

Angina pectoris:
It is type of condition in which heart lacks blood supply resulting in severe constricting pains in the chest. The pain of angina pectoris often develops and spreads from the precordium of the heart to a shoulder (usually left) and down in the arm (of left side).

Cause of angina:
It may be due to ischemia of the myocardium usually produced as a result of coronary heart disease.

Types of angina:
It may be of different types:

1. Classical angina:
This is also referred to as angina of effort or exercise induced or stable angina or typical angina.
Symptoms:
It is marked by feeling of squeezed chest as well as burning in the chest.
Mechanism:
It may be due to blockage of the large coronary vessels leading to reduced coronary perfusion. This blockage may be caused by lipid deposits in the vessels.

2. Variant angina:

It is also called as vasospastic or prinzmetal’s angina. This often occurs at rest.

Mechanism:
1. It is caused by coronary artery spasm.
2. It also occurs as a result of less flow of blood to the muscles of the heart.

3. Unstable angina:

It occurs fewer than other types of angina and its cause is not among other causes of angina. It is in between stable angina and myocardial infarction. This often occurs at night in bed.

Stable Angina ---------- Unstable Angina ----------- Myocardial Infarction

Treatment of angina:

Angina is treated by any/both of the following mechanisms:
1. Promote perfusion of the muscles of the heart
2. Less metabolic demand of the muscles of the heart

Less requirement of oxygen in patients with angina is done by one of the following mechanisms:
1. Less generation of impulses in SA node
2. Reduced conduction velocity in AV node and Purkinje cells
3. Reduced contractions of the heart muscles
4. Reduced cardiac output.

Classification of Anti-Anginal Drugs

Polycythemia vera

Polycythemia vera:
A chronic type of polycythemia without any known cause. Polyceythemia is the disease of excessive production of red blood cells in the body produced from the bone marrow.

Treatment for Polycythemia Vera:
Although allopathy is still unable to treat polycythemia vera but it works on the other conditions of the polycythemia vera like reduction of red blood cells and hemoglobin resulting in the reduction of the thickness of the blood.

Phlebotomy is normally done for the treatment of polycythemia vera. It is the procedure of removing some amount of blood from the body to reduce the amount of red blood cells.

Hydroxyurea and interferon alpha are also sometimes used in the treatment of polycythemia vera.

Herbal drugs for polycythemia:
Following most commonly occuring herbs may help in the treatment of polycythemia vera:

1. Garlic: as it may result in thinning of the blood.
2. Turmeric
3. Aloe vera

References:
Polycythemia Vera. http://www.nhlbi.nih.gov/health/dci/Diseases/poly/poly_treatments.html Accessed April 02, 2011.

Anemia

A disease of blood deficiency in which the red blood cell count is decreased resulting in poor health. In this condition, the number of red blood cells per millimeter cube or the amount of hemoglobin in 100 ml of blood is less than normal. It may also be caused by a decrease in the size of red blood cells. The mean corpuscular volume in a normal person is 82-92 µm3.

Anemia shows the following symptoms:
1. Paleness of the skin as well as mucous membranes
2. Short breath
3. Irregular or fast rate of heart beat
4. Soft systolic fluttering sound in the chest
5. Tending to become extremely tired

Main types of anemia:
There are almost 100 various types of anemia. According to the structure, anemia is of the following types:

Macrocytic anemia:
It is the type of anemia in which the size of red blood cells is larger than the normal such as in pernicious anemia. Pernicious anemia is the result of deficient intrinsic factor.

Normocytic anemia:
It is the type of anemia caused by the decrease in the number of red blood cells but the size is normal. Anemia caused by sudden blood loss is a normocytic anemia.

Microcytic anemia:
It is the type of anemia in which the average size of the red blood cell is reduced.

Simple microcytic anemia:
It is marked by smaller than normal red cells. It is found in chronic inflammatory conditions as well as in renal disease.

Microcytic hypochromic anemia:
It is marked not only by decreased red cell size but also by the decrease in hemoglobin concentration. It is seen in iron deficiency anemia and in thalassemia.

Anti-Anemic drugs