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.