Pathophysiology of life threatening headaches

1. Meningitis - is an inflammation (swelling) of the protective membranes covering the brain and
spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord
usually causes the swelling.
PATHOPHYSIOLOGY:

2. Aneurysm - causing bleeding into the brain (hemorrhagic stroke). Ruptured brain aneurysm
occurs in the space between the brain and the thin tissues covering the brain.
PATHOPHYSIOLOGY:
An aneurysm is a balloon-like bulge or weakening of an artery wall. (Similar to a balloon on the
side of a garden hose.) As the bulge grows it becomes thinner and weaker. It can become so thin
that the blood pressure within can cause it to leak or burst open. Aneurysms usually occur on
larger blood vessels at the fork where an artery branches off. When an aneurysm bursts, it
releases blood into the spaces between the brain and the skull. This space is filled with
cerebrospinal fluid (CSF) that bathes and cushions the brain. As blood spreads and clots it
irritates the lining of the brain and damages brain cells. At the same time, the area of brain that
previously received oxygen-rich blood from the affected artery is now deprived of blood,
resulting in a stroke. A subarachnoid hemorrhage (SAH) is life threatening with a 40% risk of
 death. Most common type of headache present in aneurysm is the thunderclap headache which
is the sudden onset of severe headache may occur in the absence of any known provocation.
3. STROKE - described as an insufficient supply of oxygen in the brain due to the blockage of blood
vessel going to some part of brain, which is often due to a blood clot getting trapped in the
narrow part of the blood vessel.
PATHOPHYSIOLOGY:
Formation of blood clot in the narrow part of the blood vessel will lead to decrease blood flow in
the brain decreasing also the oxygen supply which is carried by the red blood cells, brain tissues
starts to die due to insufficient supply of oxygen to the brain. However, blood clot might
sometimes dissolves on its own before there’s permanent damage which we called Transient
Ischemic Attack (TIA), but the patient should still go to the hospital because this is a warning
that a larger stroke is about to happen. The mechanism of headache in relation to stroke is still
not known.

4. BRAIN TUMOR – Brain tumors usually present with one of three syndromes: (1) subacute
progression, of a focal neurologic deficit; (2) seizure; or (3) nonfocal neurologic disorder such
headache, dementia, personality change, or gait disorder.
PATHOPHYSIOLOGY:
The headache of brain tumor disturbs sleep in about 10% of patients. Vomiting that precedes
the appearance of headache by weeks is highly characteristic of posterior fossa brain tumors.
Headache arising de novo in a patient with known malignancy suggests either cerebral
metastases or carcinomatous meningitis, or both. Head pain appearing abruptly after bending,
lifting, or coughing can be due to a posterior fossa mass