12.6 Neurological Conditions: Headache, Neuralgia, Vertigo, Seizures, Dementia, and Neurodegenerative Disease

12.6 Neurological Conditions: Headache, Neuralgia, Vertigo, Seizures, Dementia, and Neurodegenerative Disease

Quick Answer: Appendix A of the 2026 BIOM outline lists 15 neurological entries. Know each condition's typical presentation, its red flags, and how it changes acupuncture safety. Stroke, TIA, and cauda equina syndrome are covered with emergencies in Chapter 14, and radiculopathy with spinal anatomy in Section 12.5. This section covers headache types, facial neuralgias and palsy, vertigo, concussion, epilepsy, dementia, multiple sclerosis, Parkinson's disease, peripheral neuropathy, Guillain-Barre syndrome, and restless legs syndrome.

Primary Headaches

Secondary headache red flags (SNOOP4): systemic symptoms (fever, weight loss, cancer, immunosuppression), neurological signs, sudden onset ("thunderclap"), onset after age 50, a pattern change, positional headache, a headache brought on by exertion or Valsalva, and papilledema. A sudden "worst headache of my life" suggests subarachnoid hemorrhage and needs 911. In patients over 50, a new headache with scalp tenderness and jaw pain on chewing suggests giant cell (temporal) arteritis (Section 12.7).

Facial Pain and Palsy

• Trigeminal neuralgia: brief, electric shock-like pain, usually in the cheek or jaw (V2 or V3), triggered by light touch, chewing, or wind. Carbamazepine is the usual first-line drug. Trigeminal neuralgia in a young adult may be a sign of multiple sclerosis.
• Postherpetic neuralgia: burning or shooting pain that persists at least 90 days after a shingles rash in the same dermatome. Risk rises with age, and the shingles vaccine reduces it.
• Bell's palsy: sudden weakness of one whole side of the face, including the forehead (a lower motor neuron lesion of cranial nerve VII). Patients cannot close the eye or wrinkle the forehead on that side. Most recover over weeks to months; corticosteroids started within 72 hours improve recovery, and the eye must be protected from drying. Stroke usually spares the forehead, so forehead involvement points toward Bell's palsy, but any facial weakness with arm or leg weakness or speech changes is a stroke until proven otherwise.

Vertigo

Concussion and Traumatic Brain Injury

A concussion (mild traumatic brain injury) follows a blow or jolt to the head. Symptoms include headache, confusion, memory loss, dizziness, nausea, sensitivity to light, and difficulty concentrating. Emergency signs include a worsening headache, repeated vomiting, seizures, slurred speech, unequal pupils, increasing drowsiness, weakness, or loss of consciousness, and any head injury in a patient taking anticoagulants. Recovery involves a gradual return to activity, and symptoms lasting weeks (post-concussion syndrome) are common.

Epilepsy

Epilepsy is diagnosed after at least two unprovoked seizures more than 24 hours apart, or one seizure with a high risk of recurrence. Seizures are focal (starting in one area, with or without impaired awareness) or generalized (such as tonic-clonic or absence seizures). Ask patients about seizure type, triggers, warning signs, and medications. A seizure lasting 5 minutes or longer, or repeated seizures without recovery, is status epilepticus and needs 911. Seizure first aid is covered in Section 16.5.

Dementia

Alzheimer's disease causes most dementia (about 60-80% of cases), with gradual memory loss, then language, judgment, and functional decline. Other types include vascular dementia (stepwise decline after strokes), Lewy body dementia (visual hallucinations, parkinsonism, fluctuating alertness), and frontotemporal dementia (early personality and behavior change). Delirium differs: it starts suddenly, attention fluctuates, and it usually has a medical cause such as infection, dehydration, or medication. New confusion needs prompt medical evaluation. Consent may require a legally authorized representative.

Neurodegenerative Disease

• Multiple sclerosis (MS): autoimmune demyelination of the brain and spinal cord, more common in women and usually starting between 20 and 40. Symptoms include optic neuritis (painful vision loss in one eye), numbness, weakness, fatigue, bladder problems, and Lhermitte's sign (an electric sensation down the spine when bending the neck). Most patients have a relapsing-remitting course. Heat worsens symptoms (Uhthoff phenomenon), so use heat lamps and moxibustion cautiously.
• Parkinson's disease: loss of dopamine-producing neurons in the substantia nigra. The cardinal signs are a resting "pill-rolling" tremor, rigidity (cogwheel), bradykinesia (slow movement), and postural instability. Levodopa with carbidopa is the main treatment. Patients are at high risk of falls and orthostatic hypotension, so help them on and off the table.

Peripheral Nerve Disorders

• Peripheral neuropathy: numbness, tingling, burning, or loss of sensation, usually in a "stocking-glove" pattern starting in the feet. Diabetes is the most common cause in the United States. Other causes include vitamin B12 deficiency, alcohol, chemotherapy, hypothyroidism, and kidney disease. Numb feet cannot feel burns or injuries, so avoid direct heat and inspect the skin.
• Guillain-Barre syndrome: an acute autoimmune neuropathy, often 1-4 weeks after an infection (classically Campylobacter jejuni diarrhea). Weakness and tingling start in the legs and rise over days, with lost reflexes. It can paralyze the breathing muscles, so suspected cases need emergency evaluation.
• Restless legs syndrome: an urge to move the legs with uncomfortable sensations, worse in the evening and at rest and relieved by movement. Associated with iron deficiency (check ferritin), pregnancy, kidney failure, and some medications.