HEADACHE
Headache, is one of the most
common of all human physical
complaints. Headache is actually
a symptom rather than a disease
a stress response, vasodilation
(migraine), skeletal muscle
tension (tension headache), or a
combination of factors.
Definition :
A headache is a pain or
discomfort in the head , scalp , or
neck .
Types of headache :
1 ) tension type headache
2 ) migraine headache
3 ) cluster headache
4 ) other types of headache
Tension type headache :
Is the most common type of
headache , is characterized by
bilateral location . It is usually mild
or moderate intensity & not
aggravated by physical activity
Tension type headache is sub
categorize as
1) infrequent episodic
2) frequent episodic
3) chronic
Etiology :
It caused due to sustained pain
full contraction of the muscles of
the scalps & neck
Clinical manifestation :
Headache does not involve
nausea or vomiting
Photophobia – sensitivity to light
Phonophobia – sensitivity to sound
Diagnostic tests :
History taking
Physical examination
Electromyography ( EMG ) = this
test may reveals the sustained
contractions of the muscles of
the neck , face & scalp .
Migraine 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 .
Etiology :
Different theories suggest
different causes
1) vascular theory =
vasoconstriction followed by
vasodilation with resulting in
changes in blood flow causes the
throbbing pain .
2) second theory suggest that
pain is results from muscular
3)biochemical changes =
changes in serotonin level
Clinical manifestation :
Classified by IHS :
1) migraine without
aura( formerly called common
migraine )
Migraine without aura is the
most common type of
headache
2 ) migraine with aura
( formerly called as a classic
migraine )
It occurs in only 10 % of
migraine headache
Aura ( feeling of pain before it
starts ) lasts for 10 to 30 minutes
before the starts of the headache
& may include sensory
dysfunction
Tingling or burning sensation
Paresthesia
Motor dysfunction :
• Weakness
• Paralysis
• Dizziness
• Confusion
• Loss of consciousness
Diagnostic tests :
HC
PE
Neurological examination
CT , MRI
3 ) cluster headache:
it involves repeated headaches that
can occur for weeks to months at a
time followed by a period of remission.
Clinical manifestation :
Pain around the eye , forehead ,
cheeks , nose or gums
Swelling around the eye
Facial flushing
Diagnostic tests :
HC
PE
Neurological examination
CT , MRI
Other type of headache :
This type of the headache may
be the first symptoms of the
other illness
It should be due to some other
illness such as a subarchnoid
hemorrhage , brain tumors ,
trigeminal neuralgia , & any other
systemic disease
Management :
Prevention
Preventive medical management
of migraine involves the daily use
of one or more agents that are
thought to block the physiologic
events leading to an attack
There are several proven or widely
used medications for the prevention
of migraine.
Two beta-blocking agents,
propranolol (Inderal) and metoprolol
(Lopressor), inhibit the action of
betareceptors— cells in the heart
and brain that control the dilation of
blood vessels.
Calcium antagonists (verapamil HCl
Cluster headaches are unilateral
and come in clusters of one to
eight daily, with pain localized to
the eye and orbit and radiating to
the facial and temporal regions.
Nursing Management
the goals of nursing management
are to enhance pain relief. It is
reasonable to try
nonpharmacologic interventions
first, but the use of pharmacologic
agents should not be delayed.
The goal is to treat the acute event
of the headache and
to prevent recurrent episodes.
