STUDY - Technical - New Dacian's Medicine
Headache
(Classical / Allopathic Medicine)
Headaches, which
are the most common neurologic symptom, may be localized or
generalized, producing mild to severe pain. About 90% of all
headaches are benign and can be described as
muscle-contraction, vascular, or a combination of both.
Occasionally, however, headaches indicate a severe neurologic
disorder associated with intracranial inflammation, increased
intracranial pressure (ICP), or meningeal irritation. They may
also result from ocular or sinus disorders or the effects of
drugs, tests, or treatments.
Other causes of
headaches include fever, eyestrain, dehydration, and systemic
febrile illnesses. Headaches may occur with certain metabolic
disturbances - such as hypoxemia, hypercapnia, hyperglycemia,
or hypoglycemia - but they aren't diagnostic or prominent
symptoms. Some individuals get headaches after seizures or
from coughing, sneezing, heavy lifting, or stooping. (See
Comparing benign headaches.)
HISTORY:
Ask the patient to describe the characteristics of the headache, including its location, recurrence, and duration. Does it wake him from sleep or recur at certain times of the day? Does anything alleviate or aggravate it?
Ask the patient if the headache is associated with neck pain.
Ask the patient about precipitating factors, such as certain foods, exposure to bright lights, stress, trouble sleeping, hunger, elation, or yawning.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about head trauma within the last 4 weeks and about nausea, vomiting, photophobia, or vision changes.
Determine if the patient feels drowsy, confused, or dizzy.
Ask the patient if he recently developed seizures or has a history of seizures.
Ask the patient to describe the characteristics of the headache, including its location, recurrence, and duration. Does it wake him from sleep or recur at certain times of the day? Does anything alleviate or aggravate it?
Ask the patient if the headache is associated with neck pain.
Ask the patient about precipitating factors, such as certain foods, exposure to bright lights, stress, trouble sleeping, hunger, elation, or yawning.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about head trauma within the last 4 weeks and about nausea, vomiting, photophobia, or vision changes.
Determine if the patient feels drowsy, confused, or dizzy.
Ask the patient if he recently developed seizures or has a history of seizures.
Comparing benign
headaches
Benign headaches, which comprise 90% of all headaches, may be classified as muscle-contraction (tension), vascular (migraine and cluster), or a combination of both. When caring for a patient with headaches, it's important to know the particular signs and symptoms of each type.
Benign headaches, which comprise 90% of all headaches, may be classified as muscle-contraction (tension), vascular (migraine and cluster), or a combination of both. When caring for a patient with headaches, it's important to know the particular signs and symptoms of each type.
Characteristics:
Incidence
Incidence
Muscle-contraction
headaches:
Most common type,
accounting for 80% of all headaches
Vascular
headaches:
More common in
women and those with a family history of migraines
Onset after puberty
Onset after puberty
Characteristics:
Precipitating
factors
Muscle-contraction
headaches:
Stress, anxiety,
tension, improper posture, and body alignment
Prolonged muscle
contraction without structural damage
Eye, ear, and paranasal sinus disorders that produce reflex muscle contractions
Eye, ear, and paranasal sinus disorders that produce reflex muscle contractions
Vascular
headaches:
Hormone
fluctuations
Alcohol
Emotional upset
Too little or too much sleep
Foods, such as chocolate, cheese, monosodium glutamate, and cured meats; caffeine withdrawal
Alcohol
Emotional upset
Too little or too much sleep
Foods, such as chocolate, cheese, monosodium glutamate, and cured meats; caffeine withdrawal
Characteristics:
Intensity and
duration
Muscle-contraction
headaches:
Produce an aching
tightness or a band of pain around the head, especially in the
neck and in occipital and temporal areas
Occur frequently and usually last for several hours
Occur frequently and usually last for several hours
Vascular
headaches:
Weather changes
such as shifts in barometric pressure
May begin with an awareness of an impending migraine or a 5- to 15-minute prodrome of neurologic deficits, such as vision disturbances, dizziness, unsteady gait, or tingling of the face, lips, or hands
Produce severe, constant, throbbing pain that's typically unilateral and may be incapacitating
Last for 4 to 6 hours
May begin with an awareness of an impending migraine or a 5- to 15-minute prodrome of neurologic deficits, such as vision disturbances, dizziness, unsteady gait, or tingling of the face, lips, or hands
Produce severe, constant, throbbing pain that's typically unilateral and may be incapacitating
Last for 4 to 6 hours
Characteristics:
Associated signs
and symptoms
Muscle-contraction
headaches:
Tense neck and
facial muscles
Vascular
headaches:
Anorexia, nausea,
and vomiting
Occasionally, photophobia, sensitivity to loud noises, weakness, and fatigue
Depending on the type (cluster headache or classic, common, or hemiplegic migraine), possibly chills, depression, eye pain, ptosis, tearing, rhinorrhea, diaphoresis, and facial flushing
PHYSICAL ASSESSMENT:
Evaluate the patient's level of consciousness. Note signs of increased ICP - widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure.
Check pupil size and response to light, and note neck stiffness.
Occasionally, photophobia, sensitivity to loud noises, weakness, and fatigue
Depending on the type (cluster headache or classic, common, or hemiplegic migraine), possibly chills, depression, eye pain, ptosis, tearing, rhinorrhea, diaphoresis, and facial flushing
PHYSICAL ASSESSMENT:
Evaluate the patient's level of consciousness. Note signs of increased ICP - widened pulse pressure, bradycardia, altered respiratory pattern, and increased blood pressure.
Check pupil size and response to light, and note neck stiffness.
PEDIATRIC
POINTERS:
In an infant, a shrill cry or bulging fontanels may indicate increased ICP and headache.
In children older than age 3, headache is the most common symptom of a brain tumor.
In an infant, a shrill cry or bulging fontanels may indicate increased ICP and headache.
In children older than age 3, headache is the most common symptom of a brain tumor.
PATIENT
COUNSELING:
Advise the patient to take an analgesic, darken the room, and minimize other stimuli when a headache occurs.
Advise the patient to take an analgesic, darken the room, and minimize other stimuli when a headache occurs.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)