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BPS 1101 Topic 3 Headache.docx

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University of Ottawa
Biopharmaceutical sciences
William Ogilvie

Topic 3: Headache -there are different types of headaches -90% of the population suffer from cephalalgia -historically, people believed headaches were caused by demons -e.g.: a headache was treated by putting your head into the oven so the demon would leave -e.g.: metallic tractors (hot, magnetic needles) were used to "pull out the pain" -surgical cures for headaches -the cure was probably worse than the disease -surgical cures involved severe headaches -trepanation (cutting a hold in the head) was used as a surgical cure for headaches -this was thought to release the pressure in the head (people thought pressure in the head caused the headaches) -there were special tools for trepanation -there are modern practitioners of trepanation -modern trepanation is thought to prevent headaches -e.g.: the "hole in the head" movement -the brain itself does not sense pain -you can do brain surgery with only local anaesthetic -pain comes from the tissue around the skull -we need to understand the nature of the headache before treating it -there are 12 types of headaches and 60 subtypes -headaches are grouped into 2 classes: 1) Muscular Headaches -caused by pain in the muscle band around the skull -tissue around the skull is compressed by facial muscles involved in things like facial expression -in order to reduce pain, we should find a way to relax those muscles -often caused by stress -we can take painkillers to reduce muscular headaches -muscular headaches are caused by prostaglandins -ASA, ibuprofen, and naproxen can be used to interfere with prostaglandin synthesis -acetaminophen can be used to reduce the pain 2) Vascular Headaches -we can treat vascular headaches more effectively using other medications, besides pain killers -there are 3 major types of vascular headaches -toxic -migraine -toxic a) Toxic Vascular Headaches -caused by poison -poison substances evoke a response from the body which cause changes in blood circulation (i.e.: vasodilation) in the head and the increased volume of circulation in the head puts pressure on tissue, causing the pain -the most common toxin is alcohol -a hangover is caused by a toxic headache -the metabolism of alcohol contributes to the headache or can help the headache -the body uses 2 enzymes to metabolize alcohol -ethanol is converted to acetaldehyde through the enzyme alcohol dehydrogenase -acetaldehyde is converted to acetic acid through the enzyme acetaldehyde dehydrogenase -acetaldehyde is a bad poison that contributes to the hangover and the symptoms of alcohol consumption -the effects depend on how much of each enzyme you have -some people have fewer acetaldehyde dehyrdrogenase enzymes and are more sensitive to alcohol, thus experiencing stronger hangovers -they tend to get drunk easily, get worse hangovers, and handle smaller amounts of alcohol -depending on the way you ferment alcohol, it may worsen its effects -congeners (substances produced during fermentation) are present and are present in higher concentrations if the alcohol is more aged -the darker the beverage, the more severe the hangover -whiskey = Canadian -whisky = Scottish (more aged, more congeners, more severe hangover) -alcohol increases liver function -this creates an issue if you take acetaminophen for hangovers -alcohol stimulates cytochrome enzymes which then stimulates the production of toxic matabolites -some red wines contain histamines -histamines trigger inflammatory response and may cause headaches -fermented foods (e.g.: sauerkraut) may contain histamines that trigger headaches -aged cheese contains tyramine which may trigger migraines / headaches -chocolate contains phenylethylamine which may trigger headaches -hot dogs contain nitrite preservatives -nitrite is a source of nitrous oxide -nitrous oxide acts as a vasodilator that can cause headaches -nitroglycerin is also a potent vasodilator -first used in dynamites -nitroglycerin is used to prevent heart attacks because it dilates vessels and prevents the heart attack -people in dynamite factories tended to have less incidence of heart attach -MSG may cause headaches -foods with seaweed tend to taste better -MSG causes a magnifying effect of flavours that are present in the food -we can use less spices if we use MSG -in 1969, attitudes toward MSG change -based on anecdotal evidence, someone suggested that MSG is associated with headaches -this is known as "Kwok Syndrome" -people chose to avoid MSG / chinese restaurants because of this association -clinical studies show that MSG does not cause headaches -it is mostly likely a placebo effect that causes the headache -MSG is in virtually all prepared foods -on large scales / on an industrial scale, when you cook the food most of the flavor is removed -companies use MSG / flavouring to compensate for the lost flavor -MSG allows for less spice to be used and makes the food itself taste better -MSG is now labelled as hydrolyzed vegetable protein -MSG is a normal human metabolite -5% of our protein is glutamic acid -it is constantly produced in small amounts -caffeine gives rebound vasodilation -caffeine is a vasoconstrictor -it shrinks vessels too much and the body responds by dilating the vessels -if you don't have coffee for a while, you get a headache because the body dilates vessels since it is expecting the coffee to constrict vessels -brain freeze is an example of a toxic headache -when you swallow, you push food against the soft palette -when you swallow cold food, the body compensates by expanding vessels to warm the palette -the expanding vessels causes the temporary headache -we can treat toxic headaches by taking pain relievers -for hangovers, we should avoid acetaminophen and take ASA or ibuprofen -caffeine may help reduce the pain (i.e.: anacin) b) Migraine Toxic Headaches -"migraine" is an over used term -people often interchange headache with migraine -migraines only affect a small % of the population -18% in women -6% in men -migraines may last for a day or more -phase 1 of the migraine involves vasoconstriction -blood vess
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