Helpful for the nursing students

1. HEADACHE (CEPHALGIA)

2. Definition:
It may be defined as pain located in the upper
regions of the head from the orbit to the
suboccipital area.
Etiology:
• Intracranial tumors
• Hemorrhage
• CNS infections
• Acute systemic infection
• Cerebral hypoxia

3. • Severe hypertension
• Acute/chronic diseases of eyes, ears, nose&
throat.
Classification of headache according to
International Headache Society
1. Migraine
2. Tension Type Headache
3. Cluster Headache
4. Miscellaneous Headache associated with
structural lesions
5. Headache associated with head trauma

4. 6. Headache associated with vascular disorders
7. Headache associated with nonvascular intracranial
disorders
8. Headache associated with substances and their
withdrawal
9. . Headache associated with non cephalic infections
10. Headache associated with metabolic disorders
11. Headache or facial pain associated with disorders
of cranium, neck, eyes, ears, nose, sinuses, teeth,
mouth or other facial or cranial structure
12. Cranial neuralgia, nerve trunk pain
Headache not classified

5. Main types of headache
1. Migraine (Vascular Headache)
2. Tension Headache
3. Cluster Headache
4. Lumbar puncture Headache
5. Post concussion Headache

6. 1. Migraine (vascular Headache)
Onset: During puberty or in the second decade
of life and decreases in late 50’s and early 60’s
.
• It is common in females due to hormonal
changes.
• It is familial disorder.
Characteristics of pain:
• Pain is described as throbbing and pulsatile.

7. • Pain is accompanied with photophobia,
phonophobia, anorexia, nausea and vomiting
and focal neurologic signs.
Triggering factors of Migraine (Vascular
Headache):
MH is triggered by –
• Relief of intense stress
• Missing meals
• Menstruation & Ovulation
• Alcohol intake-due to vasoconstriction
• Certain food intake- chocolate, cheese, citrus
fruits, coffee, dairy products

8. • Hypoglycemia
• Stress
• Inadequate sleep
Patient finds relief in quiet and dark
environment
2. Tension headache
• It results from muscle contraction caused by
stress , anxiety or depression associated with
tension.
• Pain is described as tight band like discomfort.
• Pain builds slowly, fluctuates in severity and
persists continuously for many days.

9. • Tension headache is triggered by fatigue and
stress.
• Diagnosis is confirmed if headache occurs for
more than 15 days in a month.
3. Cluster Headache
• Pain occur in unilateral orbital, supra orbital
and temporal region.
• Pain lasts from 15 minutes to several hours.
• Pain occurs from several times in a day to
once every other day

10. • Attacks of pain occur in a series lasting for
weeks to months.
• Pain is accompanied with lacrimation, nasal
congestion, rhinorrhea, facial sweating.
• Pain is described as deep, boring, intense in
severity that patient has difficulty in remaining
still.
4. Lumbar Puncture Headache
Loss of CSF volume from LP reduces the brain
supporting cushion leading to headache. It
begins within 48 hours of LP and may be
delayed upto 12 days.

11. • Head pain is positional – begins when patient
sits, stand upright and relieved on lying in bed
or with abdominal compression.
• Pain is located in occipitofrontal region and
accompanied by nausea , stiff neck, blurred
vision, photophobia, tinnitus and vertigo.
5. Post Concussion headache
• Occurs after head injury.
• Patient C/O headache, dizziness, vertigo and
impaired memory

12. Patophysiology
Pathologic mechanisms of most headache may
be one of the following-
• Traction on or dilation of intracranial arteries
and distention of extracranial arteries.
• Traction on or displacement of intracranial
veins.
• Compression/traction/inflamation of
sensory/cranial/spinal nerves

13. • Spasm of cranial/ cervical muscles.
• Meningeal irritation or increased ICP
Assessment and Diagnostic Evaluation
• Detail History
• Physical examination of Head & Neck
• Neurological Examination
• Medication History
• Occupational History
• Description of Headache- location, quality,
precipitating factors, associated symptoms,
relieving factors

14. Diagnostic tests- CT head, MRI, Cerebral
Angiography
Blood test- CBC, ESR, electrolytes, Glucose
Clinical Manifestations-
Migraine Headache- Occurs in 4 phases
Prodrom Phase – Symptoms occur hours to days
before migraine starts.
• Depression, feeling cold, irritability, food
craving, anorexia, increased urination, change
in activity level.
• Patient experience same prodrom phase at
each episode

15. Aura Phase- last for less than an hour
• Patient has focal neurological symptoms-
visual disturbance- light & bright spots
• Numbness & tingling of lips, face, hands. Mild
confusion, slight weakness of one extremity
etc.
Headache Phase-Throbbing headache occurs
for several hours 4 to 27 hrs.
• Headache is severe with photophobia and
nausea& vomiting

16. • Recovery Phase- pain gradually subsides.
Patient sleeps for extended period
Tension Headache
C/M
• Steady constant feeling of pressure in head as
weight on head
• Begins in forehead, temple or back of neck.
Cluster Headache
C/M
• Pain is unilateral and excruciating localized on
the eye & orbit and radiates to the facial area.

17. Medical Management of Headache
• Migraine Headache
• Ergotamine tartarate
• Aspirin, acetamenophen, ibuprofen
Cluster headache
• 100% oxygen by face mask for 15 minutes.
• Ergotamine tartarate
Tension Headache
• Avoid stress
• Relaxation therapy, Muscle relaxant
• Non narcotic analgesics