eadache→Cephalgia ; one of the most common human complaints. Headache is a symptom rather than a disease.

→It is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. It ranks amongst the most common local pain complaints.

→Headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headache, like chest pain or dizziness, has many causes.

Subtypes of Primary Headache

MIGRAINE is a complex symptom characterized by periodic and recurrent attacks of severe headache. It is primarily a vascular disturbance most common in women.

TENSION HEADACHE tend to be more chronic than severe are probably the most common type.

CLUSTER HEADACHE are severe form of vascular headaches. They are seen five times more frequently in men.

Classifications Tension headache Migraine Idiopathic intracrani

al hypertension intracranial pressure

Ictal headache "Brain freeze"

Thunderclap headache

Coital cephalgia Hemicrania continua

Rebound headache "Spinal headache"

lumbar puncture Hangover Vascular headache Toxic headache

Where does the pain exist?

Assessment

Detailed history, physical assessment of head and neck.Medication historyStress assessmentToxic substance exposure.Complete description of headache itself is crucial; frequency, location, duration, type of pain and alleviating factors are obtained

Diagnostic Exams

CT scan ( Computerized Tomography Scanning )

Cerebral Angiography

MRI ( Magnetic Resonance Imaging )

EMG (Electromyography )

Causes

Organic Factors such as brain tumors or aneurysmFluid and Electrolyte Imbalance (Dehydration, FVE)Medications overuse (NSAIDS, Anti-Hypertensive, Diuretics, etc.)Emotional and Physical stressToxic Substance Exposure

Pathophysiology

Clinical Manifestations

MIGRAINE – chronic or periodic headache

Phases: Prodrome – experienced by 60% of patients. Manifested by depression, irritability, feeling cold, food cravings, anorexia, etc.

Aura – experienced by 31% of patients. Manifested by visual disturbances ( bright lights or flashes ) tingling sensation in the lips and face.

Headache – Vasodilatation and decline of serum Serotonin. Manifested by photophobia, nausea and vomiting.

Recovery Termination and postdrome - Pain gradually subsides. Manifested by localized pain, tenderness and exhaustion.

Clinical Manifestations:

TENSION HEADACHE - Steady feeling of pressure begins on the forehead, temple and back of neck.

CLUSTER HEADACHE – Excruciating pain localized to the eye and the orbit radiating to facial and temporal regions

Pharmacology

Preventive Medications:

Beta Blocking Agents: Proparanolol ( Inderal ) Metoprolol ( Lopressor ) Amitryptiline HCL ( Elavil ) Divalproex ( Valproate ) Flunarizine

PharmacologyAbortive Medications: →TRIPTANS

Sumatriptan ( Imitrex )Naratriptan ( Amerge )Rizatriptan ( Maxalt )Zolmitriptan ( Zolmig )Almotriptan

→ERGOTAMINE TARTATE – acts on smooth muscle, causing prolonged vasoconstriction of cranial vessels. Can be given orally, sublingually, subcutaneously, intramuscular, rectal or by inhalation

→OXYGEN – Administer 100% by face mask in 15 seconds.

NURSING MANAGEMENT The goal is to lessen or relieve pain.

Administer abortive medications if needed, as soon as possible.

Provide dark, quiet and peaceful environment.

Elevate head of the patient by 30º

May allow cold or hot compress on the forehead.

May decrease pain by introduction of pressure or massage.

The End