4 Headache

HEADACHE
INTRODUCTION
• Most common of all human physical
complaints
• Despite regional variations, headache
disorders are a worldwide problem,
affecting people of all ages, races, income
levels, & geographical area
• Headache is a painful and disabling feature ,
and are the most common disorder of the
nervous system.
Definition
• A headache is a pain or discomfort in the
head, scalp, or neck. The major types are
– Primary Headache
– Secondary Headache
Primary Headache
• A primary headache is due to the headache
condition itself and not due to another
cause.
Types of primary headaches are

• Migraine
• Tension Type
• Cluster
• Other types
MIGRAINE HEADACHE
• Considered as vascular headache
• Migraine headache is a recurring pain
characterized by unilateral or bilateral throbbing
Pain .
• Migraine type of headache occurs more in females
then males
• It is associated with anatomical or nervous system
dysfunction
Types
• Common migraine: it has no "aura.” About 80% of migraines are
common.
• Classic migraines (migraine with aura): it present with an aura before
the headache and are more severe than common migraines.
• A silent or acephalgic migraine: it is a migraine without head pain but
with aura and other aspects of migraine.
• A hemiplegic migraine: This can have symptoms that mimic a stroke,
such as weakness on one side of the body, loss of sensation, or feeling
"pins and needles."
• A retinal migraine: Retinal migraine causes temporary vision loss in
one eye, which can last from minutes to months, but it is usually
reversible. This is often a sign of a more serious medical problem, and
patients should seek medical care.
• A chronic migraine: It is a migraine headache that lasts for more than
15 days per month for three consecutive months.
• Status migrainosus: it is a constant migraine attack that lasts more than
72 hours.
Etiology
• Hormonal changes in women.
– Fluctuations in estrogen, such as before or during menstrual periods, pregnancy
and menopause
– Hormonal medications, such as oral contraceptives and hormone replacement
therapy.
• Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli.
– Bright lights and sun glare can induce migraines, as can loud sounds.
– Strong smells — including perfume, paint thinner, secondhand smoke
• Sleep changes. Missing sleep, getting too much sleep
• Physical factors. Intense physical exertion, including sexual activity, might
provoke migraines.
• Weather changes. Barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin.
• Foods. Aged cheeses and salty and processed foods, skipping meals or fasting.
• Food additives. Sweetener aspartame and the preservative monosodium
glutamate (MSG)
Pathophysiology
Presymptomatic hyperexcitabilty increases brain stem response to
triggers
Release of Neurotransmitters (5-HT, NE, DA, GABA, Glutamate, NO, CGRP,

Substance P, Estrogen)
Neurotransmitters activate the Trigeminal Nucleus
Dilation of Activation of
Activation of
Meningeal Activation of cervical trigeminal
Hypothalamus
blood vessels Area Postrema system (Muscle
(Hypersensitivity)
(Throbbing) spasm)
Activation of
Cortex and
Thalamus (Head
pain)
CLINICAL FEATURES
• Clinical manifestations of migraine headache are

triggered by missing meal, intense stress, thymine
rich food and sleep alteration
– Anorexia,
– Nausea, vomiting,
– Visual disturbances
Management
• Vasoconstrictor –
sumatriptan
• Triptan nasal spray in
pt with nausea and
vomiting.
Nursing care
• Should not given for
hypertension , ischemic heart
diseases
• Excess dose can cause
tremors
TENSION HEADACHE :
• Is the most common type of
headache, is characterized by
bilateral location. It is usually
mild or moderate intensity and not
aggravated by physical activity.
Tension type headache is sub

categorize as
– Infrequent episodic
– Frequent episodic
– Chronic
ETIOLOGY
• It caused due to sustained pain full contraction of the
muscles of the scalps and neck
• Physical or emotional stress
• Alcohol use
• Caffeine (too much or withdrawal)
• Colds, the flu, or a sinus infection
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigue or overexertion
Management
• Over-the-counter (OTC) pain medicines,
such as aspirin, ibuprofen, or
acetaminophen
• Narcotic pain relievers are generally not
recommended
• Muscle relaxers
• Tricyclic antidepressants to prevent
recurrences
Health Education
• Keep warm if the headache is associated with
cold.
• Use a different pillow or change sleeping
positions.
• Practice good posture when reading, working,
or doing other activities.
• Exercise the neck and shoulders frequently
when working on computers or doing other
close work.
• Get plenty of sleep and rest.
Secondary Headache
• A secondary headache is present because of
another condition. The management of
secondary headache focuses on diagnosis
and treatment of the underlying condition.
The types of secondary headache are
• Systemic infection E.g. Meningitis,

• Head injury
• Vascular disorders E.g. Aneurysm Rupture, Stroke
• Subarachnoid hemorrhage
• Brain tumor
Types
• There are two types of cluster headaches:
episodic and chronic.
• Episodic cluster headaches- occur

regularly between one week and one year,
followed by a headache-free period of one
month or more.
• Chronic cluster headaches- occur regularly
for longer than one year, followed by a
headache free period that lasts for less than
one month.
Etiology
• Exact cause is unknown
• Sudden release of histamine, serotonin
• Hypothalamic issues
• Others
– Alcohol and cigarette smoking
– High altitudes (trekking and air travel)
– Bright light (including sunlight)
– Exertion (physical activity)
– Heat (hot weather or hot baths)
– Foods high in nitrites (bacon and preserved meats)
– Certain medicines
– Cocaine
Clinical manifestation
• Excruciating pain that is generally situated in, behind or
around one eye, but may radiate to other areas of face,
head and neck
• One-sided pain
• Restlessness
• Excessive tearing
• Redness of your eye on the affected side
• Stuffy or runny nose on the affected side
• Forehead or facial sweating on the affected side
• Pale skin (pallor) or flushing on your face
• Swelling around your eye on the affected side
• Drooping eyelid on the affected side
Medication
• Pain medication relieves your headache pain once it has
begun.
Treatments include:
• Oxygen: Breathing 100% pure oxygen when the headache

begins can help relieve symptoms.
• Triptan medications: A nasal spray medication called

sumatriptan (Imitrex), or other tripitan medications
constrict blood vessels, which can help ease your headache.
• DHE: An injected medication called dihydroergotamine
(DHE), can often relieve cluster headache pain within five
minutes of use.
• Note: DHE can’t be taken with sumatriptan, causes excessive

narrowing of blood vessels in the body.
• Capsaicin cream: Topical capsaicin cream can be applied to
the painful area.
• Blood pressure medications, such as
propranolol or verapamil which relax
your blood vessels
• Steroid medications, such as
prednisone, which reduce
nerve inflammation
• A medication called ergotamine that
keeps your blood vessels from
dilating
• Antidepressant medications
• Anti-seizure medications, such as
topiramate and valproic acid
• Lithium carbonate
• Muscle relaxants, such as baclofen

Surgery
• As a last resort, a surgical procedure can be
used to disable the trigeminal nerve.
Risk factors
• Sex. Men are more likely to have cluster
headaches.
• Age. Most people who develop cluster headaches
are between ages 20 and 50, although the
condition can develop at any age.
• Smoking. Many people who get cluster
headache attacks are smokers. However,
quitting smoking usually has no effect on the
headaches.
• Alcohol use. If you have cluster headaches,
drinking alcohol during a cluster period may
increase your risk of an attack.
• A family history. Having a parent or sibling who
has had cluster headache might increase your risk.
LUMBAR PUNCTURE HEADACHE
• Headache after Lumbar
puncture.
• Occurs within 48 hrs but is
delayed up to 12 hrs.
• It begins when the client sits or

stands upright.
• Reduction with abdominal
compression worsened with
headshaking.
DIAGNOSTIC TESTS :
• History taking
• Physical examination
• Electromyography ( EMG )
= this test may reveals the
sustained contractions of
the muscles of the neck ,
face & scalp
Nursing management
• Help to identify the stressful stimuli and learn
to cope with that.
• Daily exercise, relaxation and socialization.
• Encourage to avoid beverages
• Massage and moist heat on head to reduce
tension headache .
• Patient should avoid smoking
• Provide quite dim light
• Comfort measures and stress reduction
technique.
THANK YOU

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HEADACHE

Types of primary headaches are

Release of Neurotransmitters (5-HT, NE, DA, GABA, Glutamate, NO, CGRP,

Neurotransmitters activate the Trigeminal Nucleus

• Clinical manifestations of migraine headache are

Tension type headache is sub

• Systemic infection E.g. Meningitis,

• Episodic cluster headaches- occur

• Oxygen: Breathing 100% pure oxygen when the headache

• Triptan medications: A nasal spray medication called

• Note: DHE can’t be taken with sumatriptan, causes excessive

• Muscle relaxants, such as baclofen

• It begins when the client sits or

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