09 Jan Diagnostic presentation Headache United States University
Diagnostic presentation
Headache
United States University
Introduction
Headache is the most common pain in the united states.
Headache means pain or discomfort in the head, face, or neck.
Headache can be caused by inflammation or spasm related to cranial vessels, nerves, or muscles Headache can be primary or secondary. (Dlugasch & Story, 2021)
Classification of headache
Primary headache
Most common, not a symptom of underlying an underlying disease
Benign
Can be recurrent
It mainly occurs early in an individual
Decrease after ages 40 to 50
Migraine
Tension-type headache
Trigeminal autonomic cephalgia
Other primary headache disorders (Rizzoli & Mullally, 2018).
Secondary headache
Caused by an underlying condition
Trauma or injury to the head or neck
Cranial or cervical vascular disease
Nonvascular intracranial disorder
A substance or its withdrawal
Infection
Affliction of homeostasis
Illness of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cervical structure
Psychiatric disorder (Rizzoli & Mullally, 2018).
The red flag of headache
If an older patient complaint of New headache
Abnormal neurologic examination such as mental status changes and papilledema
If there is any New change in the headache pattern
Intensifying headache
New headache if in case of HIV risk factors, cancer, or an immunocompromised status
Systemic illness signs (e.g., fever, stiff neck, rash)
If precipitate by cough, exertion, Valsalva maneuver
If the Headache in pregnancy or postpartum period
If a patient says it is the First or worst headache of my life (Rizzoli & Mullally, 2018).
Pathophysiology of headache
Stimulation of primary nociceptors
Lesions in the pain-producing pathway of PNS and CNS
Pain producing structure
Scalp
Middle meningeal artery
Dural sinuses
Flax cerebri
Proximal segment of the large pial arteries (Dlugasch & Story, 2020)
Pathophysiology of headache continue
There are no nociceptors in the brain parenchyma
So the pain originates from surrounding structures, such as blood vessels, meninges, muscle fibers, facial structures, and cranial or spinal nerves.
Any stretching, dilatation, constriction, or any nociceptor when they stimulate stimulation structures can cause the perception of headache.
The secondary headache depends on the cause and diseases
( Rosenthal & Burchum, 2021)
migraine headache
Migraine headache is a headache associated with systemic complaints. The person feels a severe throbbing pain or a pulsing sensation, usually on one side of the head, along with nausea, vomiting, and extreme sensitivity to light and sound. The attacks can last for hours to days, and the pain can be severe that it interferes with daily activities (Dlugasch & Story, 2020).
Triggers to migraine headache
Emotional stress
Hormonal change during menstruation
Alcohol intake
Change in weather
Odors
Disturbance in sleep or not getting enough sleep
migraine headache
Migraine without aura
Throbbing pain that starts on one side of your head, moving around tends to worsen the pain, the patient feels nauseous, dizzy, and light sensitivity and sensitivity to the sound.
The duration can be from the 4 to 72 hrs.
Migraine with aura
The person feels visual disturbances before a migraine begins, followed by common migraine symptoms
This type of migraine can range from a few minutes to a full hour, usually before the migraine attack itself starts.
The migraine itself can last from 4-72 hours.
Menstrual Migraine
this type of Migraine started with the periods
it can be last from 4 to 72 hrs.
Vestibular Migraine
A person can feel balance trouble, dizziness, and vertigo
It can be last from a few seconds to a few days
.Migraine can be without the headache
migraine headache
Signs and symptoms of Migraine headache
Prodromal signs; Irritability, euphoria, depression, yawing, food craving, and constipation
These symptoms occur one to 2 days before the onset of headache
Throbbing pain
Nausea and vomiting
Photophobia
Phonophobia
(Dlugasch & Story, 2021)
migraine headache diagnostic test
Detail history regarding headache
Physical examination
Urine drug screen to find out illicit drug use
CBC, CMP, TSH, ESR
Emergency CT of Head without contrast If patient complaint the worst headache
CT of the head if alerted mental status or nuchal rigidity
If orbital bruit is present, then needed neuroimaging
LP indicated if children with AMS
Sinus film in severe case to rule out mass or the lesions
(Cash et al., 2021)
migraine headache drugs
Valproic acid
Topiramate
Beta-blockers
Triptans with NSAIDs for acute migraine headache
Triptans for menstrual migraine
Antiemetics for nausea and vomiting, which is caused by migraines
Erenumab, fremanzumab, galcanezub for prophylaxis
Triptan such as sumatriptan imitrex, alsuma, Rizatriptan, zolmitriptan, naratriptan for acute migraine
(Cash et al., 2021)
Patient teaching
Educate patient about the red flags of headache
Teach the patient to maintain a record for a headache at all times.
Teach the patient to get enough sleep
Teach about the medication, its effect, and side effects
Teach about stress reduction
Explain to the patient how to avoid triggers
Teach about the relaxation technique
(Cash et al., 2021)
Tension-type headache
Tension-type headache is the most common type of headache, also called the stress headache. The recurrent headaches are mild to moderate intensity, have a bilateral location, pressing or tightening quality, and are not precipitated by routine physical activity. (Dlugasch &Story, 2020).
Diagnostic tests
Diagnostic test
Detail history
Physical exam
If worse headache then CT scan of the head
Symptoms and triggers of tension headache
Symptoms
Non-throbbing pain
Head feeling dull and full
Bilateral headache
Not associated with nausea or photophobia
Triggers
Stress
Tension
Migraine
Excessive use of smoking
Excessive eye straining
Overuse of caffeine or withdrawal
Sinus infection or flu
(Cash et al,., 2021)
Pharmacological and nonpharmacological treatment of tension headache
Relieve tension
Avoid triggers
Improve sleep pattern
Avoid caffeine
Drug therapy, pain reliever is the first-line therapy
Aspirin or , ibuprofen
(Cash et al., 2021)
Cluster headache
Cluster headache is a type of headache in which a person has a short burst of unilateral orbital pain that feels several times a day.
(Dlugasch & story, 2021).
Signs and symptoms and diagnostic tests for cluster headache
Signs and symptoms of cluster headache
Most common in men
It can occur at any age
Smoking is the leading risk factor
Headache can last a few minutes to hours
Throbbing and stabbing like headache
Pain along with excessive tearing
Runny nose Nasal congestion and eye redness
Sweating
Diagnostic
Based on history and physical
If abnormal signs, then CT scan of the head
Lithium level if the patient is taking lithium
(Dlugasch & story, 2021).
Pharmacological and nonpharmacological treatment of cluster headache
Avoid triggers
Improve sleep pattern
Suboccipital steroids injection effective prophylactic treatment
Verapamil is the first line for preventive, chronic type of cluster headache
In an acute attack, oxygen, sumatriptan is the treatment of choice
Lithium is the second-line drug therapy for the prevention
Educate patient regarding avoiding drug misuse
Teach the patient regarding drugs, their action, and the side effects
Teach the patient to eat a well-balanced diet
(Rosenthal & Burchum, 2021)
Conclusion
Headache is the most common cause of pain. It’s essential to use non-pharmacological methods to relieve headaches, such as behavior therapy, physical therapy, lifestyle changes. Teaching relaxation techniques that help ease muscle tension, meditation, progressive muscle relaxation, and self-hypnosis are good techniques to relieve headaches.
References
Cash, J. C., Glass, C. A., & Mullen, J. (2021). Family practice guidelines. Springer Publishing Company.
Dlugasch, L., & Story, L. (2021). Applied pathophysiology for the advanced practice nurse (1st ed.). Jones & Bartlett Learning.
Rizzoli, P., & Mullally, W. J. (2018b). Headache. The American Journal of Medicine, 131(1), 17–24. https://doi.org/10.1016/j.amjmed.2017.09.005
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants. Elsevier.
