Bleeding nose and headache

PMC

Discussion

Three distinct aspects deserve our consideration: epistaxis, aura topography and natural history.

This is the third report of migraine-induced epistaxis but the first involving aura. Epistaxis appeared between the peak severity of headache and the beginning of its resolution, similar to previous descriptions . Therefore, it could be considered as a symptom of the resolution phase of migraine. This chronological profile is consistent with one of the classical concepts of the resolution of migraine (lytic state or resolution by secretion) which may include vomiting, diuresis, lacrimation, sweating or epistaxis . Co-occurrence of a throbbing headache and epistaxis could be due to the activation of the trigeminovascular system, causing vasodilation of dependent branches of the internal and external carotid arteries . However, this attractive hypothesis presents an epidemiological weakness: migraine is common but descriptions of migraine with epistaxis are rare. The lack of similar cases reported is intriguing. The scarcity may be due to the depreciation of this symptom or the lack of a guided anamnesis. Interestingly, descriptions of migraine sufferers with epistaxis can be found on non-scientific websites.

The inclusion of a specific question about epistaxis in the questionnaires of headache research centers would allow us to estimate the prevalence, timing and features of these episodes during migraine attacks, contributing to a better understanding of them.

The aura had a peculiar topography, inconsistent with the classical analytical neurological semiology. Motor aphasia was accompanied by weakness, even when it was in the left hand. The coexistence of aphasia and aura symptoms in the non-dominant hand has been previously documented . It is well known that hand paresis is practically universal in SHM, whereas the lower limbs and face are only affected in half of all cases . In this case, the lower limb was affected by weakness in the absence of deficits affecting the face or upper limb. The headache location was not contralateral to the aura, as previously described . This set of evidence suggests that the spreading depression can initiate in a stereotyped manner in the occipital cortex (typical scintillating scotoma) and silently spread anteriorly or affect the cerebral cortex in an uneven manner. The medial frontal cortex (or subcortical structures) was affected in episodes of crural aura and primary somatosensory and motor areas of the convexity were relatively spared. These findings support the concept that pathophysiological phenomena of migraine are bilateral and pan-cerebral, regardless of the laterality of their capricious clinical manifestations.

The natural history of this disease has some peculiarities. It started with MA at the age of 20, and only 15 years later the patient exhibited three episodes of SHM followed by progressive remission (migraine swan song). It could be argued that this is a coincidence of two types of migraine. However, the scintillating scotoma, which is stereotyped and distinctive, is common to both MA and SHM episodes. Assuming the patient suffers from a single disease, the present case seems to demonstrate that the appearance of complex auras requires improbable interactions between environmental and endogenous conditions in individuals with a genetic predisposition.

Interestingly, the patient’s son had similar episodes of MA. Some asymptomatic relatives of SHM patients may be genetically affected but not subjected to strong enough triggers. It will be interesting to see if our diagnosis will evolve to familial hemiplegic migraine, which often occurs in ‘sporadic’ cases.

9 Types of Headaches: Symptoms, Triggers, and More

The World Health Organization estimates that nearly half of all adults have had a headache at least once within the last year. Many of us are accustomed to the disruptive pain of a headache occasionally.

There are more than 100 different types of headaches, each with its own origins and symptoms. While most headaches are brief and aren’t a cause for concern, being able to identify which type of headache you are experiencing can help you better understand your health.

Primary Types of Headaches

Primary headaches are episodic, recurrent, patterned headaches that aren’t produced by an underlying cause or condition, says the International Headache Society (IHS). The most common types of primary headaches are:

1. Cluster Headaches

These very painful, one-sided headaches can recur regularly — even multiple times daily — and last anywhere from 15 minutes to three hours. Common triggers include alcohol, cigarettes, high altitudes, and certain foods. Cluster headaches may consist of red or teary eyes, a runny or stuffy nose, facial flushing or sweating, and a restless feeling. They are often treated with triptans (migraine medication) or oxygen therapy.

2. Tension-type Headaches

Tension-type headaches (TTH) — one of the most common headache varieties — cause mild to moderate head pain due to the tightening of the muscles of the neck and scalp. These headaches may last from half an hour to several days. Common triggers include stress, anxiety, shoulder and neck muscle stiffness, or sleep deprivation. TTH can be treated with over-the-counter pain relievers.

3. Migraines

Migraine headaches may last from 30 minutes to several days, causing throbbing pain on one or both sides of the head, dizziness, nausea, and fatigue, along with light, noise, or smell sensitivity. Often preceded by visual disturbances, such as halos, flashing lights, zigzag lines, or blind spots, migraines are related to blood vessel contractions and other brain changes. Triggers include environmental or weather changes, stress, and lack of sleep. Migraines may be treated by preventive and pain-relieving medications, says the IHS. Preventive measures may include trigger avoidance and stress management.

Secondary Types of Headaches

A secondary headache is caused by an underlying condition. Common types of secondary headaches are:

1. Exertion Headaches

These brief, throbbing headaches can occur on both sides of your head. Exertion headaches can happen following periods of intense physical activity like running, weightlifting, and sexual intercourse. Treatment includes over-the-counter pain relievers and melatonin.

2. Sinus Headaches

These are deep and constant headaches that result from inflamed or infected sinuses. Sinus headaches may be accompanied by symptoms like sinus pressure, nasal discharge, watery eyes, ear fullness, fever, and facial swelling. Treatment includes medications for sinus inflammation or sinus infection.

3. Hormonal Headaches

These throbbing headaches start on one side of the head and include light sensitivity and nausea. Hormonal headaches are due to hormonal fluctuations during menstruation, pregnancy, menopause, and hormonal contraceptive use.

4. Rebound Headaches

Also known as medication overuse headaches, these chronic headaches are caused by overusing certain medications. Overusing any pain reliever for more than 15 days a month — or taking triptans for more than 10 days a month — can increase your risk for rebound headaches. These headaches resolve after stopping overuse, says the IHS.

5. Post-traumatic Headaches

A post-traumatic headache can occur within seven days of a head injury. The American Migraine Foundation recommends seeking immediate medical attention if the headache is accompanied by dizziness, fatigue, decreased concentration, memory problems, insomnia, anxiety, irritability, or a personality change.

6. Hypertension Headaches

These headaches occur when your blood pressure becomes dangerously high — over 180/110. Hypertension headaches feel like pulsations on both sides of your head and can be accompanied by vision changes, chest pain, shortness of breath, or nosebleeds. Hypertension headaches are treated by lowering blood pressure.

When Headaches Are Dangerous

Most types of headaches aren’t dangerous, but some may be the result of a more serious condition that requires emergency care. The National Institutes of Health recommends speaking to your doctor if your headaches:

  • occur frequently or increase in severity
  • occur daily
  • arise suddenly and intensely
  • change in pattern or nature
  • are accompanied by fever, high blood pressure, weakness, fainting, stiff neck, vision changes, sensation changes, loss of coordination, seizures, or confusion

If you’re having headaches, don’t suffer in silence. Discuss your symptoms with your doctor. Once your headaches are correctly diagnosed, you can begin the appropriate treatment plan for your symptoms.

Nosebleeds. Everyone has had one. While they are often frightening, they are rarely anything more than a nuisance.

What Causes a Nosebleed?

When the membranes lining the inside of the nose dry out and become irritated, the blood vessels break, causing a nosebleed. These are more common in the winter months, when the air is cold and dry. Other factors that may contribute to nosebleeds include:

  • Colds
  • Allergies
  • Sinus infections
  • Nose picking
  • Blowing the nose too hard
  • Frequent sneezing
  • Overuse of nasal sprays
  • Foreign objects in the nose
  • Trauma to the nose

There are two types of nosebleeds, anterior and posterior. Anterior nosebleeds are the most common and are caused by bleeding in the front part of the nose. The bleeding from a posterior nosebleed comes from an artery in the back portion of the nose.

If nosebleeds are chronic or occur frequently, they may be the result of high blood pressure or other vascular diseases or, in rare cases, a serious medical condition like a tumor.

What Are the Symptoms of a Nosebleed?

Bleeding from only one nostril is the most common symptom of a nosebleed. Usually a nosebleed from both nostrils is due to a heavy flow from one nostril; the blood has just backed up and overflown into the other. If blood drips down the back of the throat into the stomach you may spit up or vomit blood. Excessive blood loss can cause a feeling of dizziness, light-headedness and fainting.

How Do You Treat a Nosebleed?

More often than not, a nosebleed can be easily controlled at home. Sit up straight, lean your head forward and pinch the nostrils together with your thumb and index finger for 10 minutes. Try not to swallow any blood as it may cause you to vomit. Once the bleeding has stopped, try not to blow your nose for the next 24 hours and avoid dry air.

If this home remedy does not stop the bleeding, you will have to visit your Carlsbad doctor. If the bleeding is coming from a blood vessel at the front of the nose, your doctor can easily seal up the opening with silver nitrate in a process called cauterizing. If the blood vessel is further back, nasal packing may be needed. This involves packing the nasal cavity with gauze, which puts pressure on the vessel and will stop the bleeding. The packing is left in place for 24 to 72 hours.

If the bleeding is coming from the back of the nose (a posterior nosebleed) a special type of packing is needed. You may need to be hospitalized and will be given a sedative and pain medication. The packing is left in place for 48 to 72 hours. If the bleeding still does not stop, surgery may be needed.

For those who are prone to nosebleeds, your Carlsbad otolaryngologist recommends taking steps to prevent them. Keep the nasal lining moist with a light coating of petroleum jelly several times a day, or use a saline nasal spray. Run a humidifier, especially if you live in a dry climate. Quit smoking; this causes dryness and irritation.

For more information, contact your Carlsbad doctor today.

Nosebleed (Epistaxis)

What Is It?

Published: February, 2019

The inside of the nose is covered with moist, delicate tissue (mucosa) that has a rich supply of blood vessels near the surface. When this tissue is injured, even from a minor nick or scratch, these blood vessels tend to bleed, sometimes heavily. Nosebleeds near the front of the nose, called anterior nosebleeds, are very common since this is the most accessible area to injury. The most frequent location is the nasal septum, the wall between the two sides of the nose. In most cases, this type of nosebleed is not serious. It usually can be stopped with some local pressure and a little patience.

Only rarely is a nosebleed life threatening or fatal. In these cases, the hemorrhage (severe bleeding) is usually from an artery in a posterior location, higher and deeper in the nose. Posterior bleeds usually drain down the back of the throat, but can also bleed out of both nostrils. Also, in most cases of severe nosebleeds, the person has another health problem, such as high blood pressure or a bleeding disorder, or the person takes a blood-thinning medication that slows down the blood-clotting process.

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