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Hi guys. Um ok, thank you so much for being here. Um And joining me this early in the morning. Um So, yeah, so the first neuro tutorial of the day is basically gonna be on um headaches and cerebral vasculature. Um I hope this will be nice quick concise. Um It gives you everything you kinda need in this realm. Ok. So, so a quick timeline of what's gonna happen today. So we're gonna start by talking a little about headaches um and then move on to talk about hemorrhages and then finally finish off um with stroke. Ok. So in terms of headaches, so there are two main types of headaches that you guys need to know. So the first one is primary headache and obviously secondary headaches. So primary headaches are the main type of headaches that um well, it would be like your migraines, your tension type, your cluster is like what you kind of associate with when you think of headaches. Um but secondary headaches are headaches that are precipitated by other conditions. And these could be, for example, hemorrhages, it could be like meningitis. Um There are a range of causes, but I think what you guys see here is the table that you guys see here is a good kind of red flag symptom table for um secondary headaches. So it helps you kind of like detect them and kind of differentiate them from primary headaches. So age onset um systemic symptoms and neurological signs. So age obviously, well, if it's a new onset headache or a different headache in someone older than 50 years, then you'd kinda be worried. Um, it's something else, something more severe. Um in terms of onset, if it's a sudden abrupt onset, for example, you think um subarachnoid hemorrhage, you think thunderclap headache, um systemic symptoms. If there's any fever, neck stiffness, those are um symptoms for meningism. So you probably thinking meningitis um and then neurological signs, any focal neurology, any swollen optic disc, you wouldn't get these symptoms in a primary headache. So you'd probably be thinking, oh, is it something more severe? Is it something different? Um Yeah. And then, so we're gonna be starting with primary headaches. Um And there are three main types of primary headaches you guys need to know. So, migraine tension type cluster headaches. Um and this table, I think s sort of kind of summarizes the main characteristics that kind of go across all these headaches, um which ma makes, I guess easier for you to learn. I mean, made it easier for me to learn. So starting. So I'm gonna go through this one by one, starting with migraine headaches. So in terms of duration, they tend to be longer-lasting. So they can last for a few hours to a few days. In terms of severity, it's a moderate to severe headache, it is aggravated by physical activity. So a lot of the times people presenting with a migraine, you hear that they want to lie down, they don't wanna be walking around. Um it'll be pulsating and most of the time unilateral. So they'll be describing it as kind of like a throbbing headache on one side of the head and then moving on to tension type headaches. So the way I like to remember this is that it's kind of a migraine but flipped. So everything that a migraine is a tension type is not um apart from really the duration, it is classified as long-lasting, but it only last for 30 minutes to a few days. Whereas migraines tend to start off. Well, they tend to last for four hours to a few days. So it kind of varies there, but it's still considered a longlasting headache. Um in terms of severity, it's mild to moderate, it's not really aggravated by physical activity. So you won't, well, people, you will, you won't hear that people will need to lie down particularly or whatever. Um It's not pulsating and it tends to be bilateral. Um and then cluster headaches tend to be in a category of its own. I like to think of it as like its own thing. It's a very unique. Um and well, it has its own very defining features. So cluster headache tend to be really shortlasting. So it only lasts for around 15 minutes to a few hours, but it's very severe. Most of the time you'll hear patients describe it as kind of being like the most severe pain that they've ever felt. Um and they will be restless. So, um so when patients come in with a cluster headache, they'll have to be pacing around, but like they can't sit still and they'll kind of be like moving around and like clutching one side of the head because it is, well, it's strictly unilateral. So they'll be like clutching one side of the head, they'll be pacing around and be like, oh my, like it's the most pain I've ever felt, whatever, whatever. Um But that's, that's a cluster headache. Ok. So starting off with migraines, I'm gonna go into a bit more detail um with a different type of characteristics and, you know, kind of what makes a migraine a migraine. Um So in terms of presentation, you can see in the diagram here that it, it's like, it's very much like a one, it tends to be really like a one-sided, like around like the full face situation. Um Yeah, that's, that's how people kind of describe it when they present with a migraine. Um And then, so migraines tend to have characteristics on top of this, that kind of allows you to detect a migraine easily. So usually they'll present with one of either nausea and vomiting or photophobia and or photo. So, photophobia is when people are sensitive to light and photo and sensitivity to really loud sounds. So on top of having to just um lie down and like, you know, cause always it, it is aggravated by physical activity. So they'll want to lie down. Um you'll hear that they want to have the lights off. They want, you know, no sounds around them. They wanna have the curtains drawn, they just wanna be sitting in the, lying down in the dark, basically. Um That's where they feel the most comfortable. Um And they may or may not also have auras which are basically, you can think of it as like preheadache, like a warning, basically a prewarning for a headache and it'll usually last 5 to 30 minutes. Um And most of the time, the most common presentations of an aura are either expanding CS or other visual disturbances and they don't happen with everyone. But when they do, I think it just makes it more obvious that it, it is a migraine. So um migraine with a migraine, you can, you go through basically several phases of a migraine every time someone does have a migraine. So you start off with premonitary phase, which is when you know, you have symptoms of yawning polyuria, light sensitivity, you can't concentrate and then you, you go on to the aura phase, which as I talked about before is when you have elemental germs or like expanding CS, basically like a warning before the actual migraine itself. And then you move on to the headache phase, which is the actual migraine. Um And then you have the resolution phase, which is where patients tend to need to rest up and sleep. And then lastly, the recovery phase which um can take up to 48 hours. But it's kind of like the returning to normal phase. They will feel like the mood is disturbed, they'll have food intolerance, they kind of feel really hung over and really groggy um for a few days, but that's like the end, end of the pathway, I guess. Um Yeah. And so every time someone goes through a migraine, it, it will, they will tend to go through all the different phases of migraines. Ok. And then on the management of migraines. Um So there are different ways to manage a migraine depending on.