This document discusses different types of headaches including migraines, tension headaches, and cluster headaches. It describes the pathophysiology, clinical manifestations, diagnostic evaluation, and management of headaches. Migraines are caused by changes in serotonin levels and vasodilation/constriction and result in throbbing pain on one side of the head. Tension headaches cause steady pressure and are due to prolonged muscle contraction. Cluster headaches involve severe pain around the eye. Treatment involves medications to relieve pain or prevent headaches as well as lifestyle changes and relaxation techniques.

1. HEADACHE
Compiled by-
Mr. Ashish Roy
(Nursing Tutor)

2. Headache
Headache, or cephalgia, is one of the most
common of all human
Physical complaints :
Headache is actually a symptom rather than a
disease entity; it may indicate organic disease
(neurologic or other disease), a stress response,
vasodilation (migraine), skeletal muscle tension
(tension headache), or a combination of factors.

3. Types
Primary Headaches
• Migraine headache: consists of initial vasospasm followed
by dilation of intracranial and extracranial arteries; occurs
in about 10% of population
– Caused by hyperactivity to the neurotransmitter serotonin;
familial predisposition.
– Attack may consist of any of five phases: prodrome, aura,
headache, resolution, and postdrome.
– Classified with or without
• Tension headache: due to irritation of sensitive nerve
endings in the head, jaw, and neck from prolonged muscle
contraction in the face, head, and neck; mild or moderate
intensity that does not prohibit activity.
– Precipitating factors include fatigue, stress, poor posture.
• Cluster headache: release of increased histamine results in
vasodilation

4. • Secondary headache is a symptom associated
with an organic cause, such as a brain tumor,
aneurysm, subarachnoid haemorrhage, stroke,
severe hypertension, meningitis, and head
injuries.

5. Pathophysiology
• Headache are believed to be associated
constriction and dilation of intracranial and extra
cranial arteries.
• During migraine attack , certain biochemical
abnormalities , including local leakage of a
vasoactive polypeptide called neurokinin through
the dilated arteries and a decrease in the plasma
level serotonin,( a potent vasoconstrictor)
• Cause marked vasodilatation of arteries resulting
headache.

6. Clinical Manifestations
MIGRAINE
• The migraine with aura can be divided into four phases:
prodrome, aura, the headache, and recovery (headache
termination and postdrome).
• Prodrome.
The prodrome phase is experienced by 60% of patients with
symptoms that occur hours to days before a migraine headache.
Symptoms include depression, irritability, feeling cold, food
cravings, anorexia, change in activity level, increased urination,
diarrhea, or constipation.
• Aura Phase. Aura occurs in up to 31% of patients who have
migraines :
The aura usually lasts less than an hour.
• Visual disturbances (i.e., light flashes and bright spots) are
common and may be hemianopic (affecting only half of the
visual field). numbness and tingling of the lips, face, or hands;
mild confusion; slight weakness of an extremity; drowsiness;
and dizziness.

7. • Headache Phase.
As vasodilation and a decline in serotonin levels
occur, a throbbing headache (unilateral in 60% of
patients) intensifies over several hours.
This headache is severe and incapacitating and is
often associated with photophobia, nausea, and
vomiting. Its duration varies, ranging from 4 to 72
hours
• Recovery Phase. In the recovery phase
(termination and postdrome),the pain gradually
subsides. Muscle contraction in the neck and
scalp is common, with associated muscle ache
and localized tenderness, exhaustion, and mood
changes.

8. Tension headache
Steady, constant feeling of pressure that usually
begins in the forehead, temple, or back of the
neck.
Cluster headaches
Pain localized to the eye and orbit and radiating
to the facial and temporal regions.
• Nasal congestion eye discharge.

9. Diagnostic Evaluation
• History – Emotional Stress
• Physical Examination : Complete neurological Assessment
• CT (Computed tomography)
• MRI (Magnetic Resonance Imaging)
• CEBREAL ANGIOGRAPHY
• BLOOD INVESTIGATIONS – CBC & ELEVATED HORMONES
LEVEL
• Cause of Headache :
Symptom of endocrine, hematologic, gastrointestinal,
infectious, renal, cardiovascular, or psychiatric disease.

10. Management
Pharmacologic Treatment
• Aspirin, acetaminophen, and NSAIDs for mild to
moderate pain of tension, sinus, or mild vascular
headaches.
• Some drugs may abort vascular headaches if
taken at the onset, including methysergide
(Sansert), a serotonin antagonist.
• Inhalation of 100% oxygen may abort a cluster
headache.
• Some drugs may be used continuously as
prophylactic treatment for recurrent migraines,
including beta-adrenergic blockers, calcium
channel blockers, and antidepressants.

11. Continued…
• Antihistamines and decongestants may be
effective for sinus headaches.
• Corticosteroids may be used for temporal
arteritis.
• Occasionally, opioid analgesics, muscle
relaxants, and anti-anxiety agents may be
needed for severe pain.

12. Nursing Management
• Relaxation techniques, paced breathing.
• Trigger identification and control of such
factors as intake of alcohol (red wine), skipped
meals, oversleeping, or undersleeping.
• Rest in a quiet, dark room at onset of
headache.
• Routine exercise program.

13. Nursing Diagnosis
• Acute Pain related to headache
• Ineffective Coping related to chronic and/or
disabling pain
• Anxiety related to the disease condition.
• Altered cerebral tissue perfusion related to
disease condition.

14. THANKYOU FOR YOUR ACTIVE
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THE END.