Headache is one of the most common human complaints worldwide. There are two main types of headaches - primary and secondary. Primary headaches include migraines, tension headaches, and cluster headaches, which are caused by the condition itself rather than another cause. Migraines are severe headaches that can cause throbbing pain on one or both sides of the head along with nausea and sensitivity to light and sound. Tension headaches cause mild to moderate dull pain across both sides of the head that is often exacerbated by stress. Cluster headaches involve excruciating pain around one eye and are more common in men. Secondary headaches are caused by underlying conditions like infections, head injuries, or tumors. Diagnosis involves history and exams, while treatment

1. HEADACHE

2. INTRODUCTION
• Most common of all human physical
complaints
• Despite regional variations, headache
disorders are a worldwide problem,
affecting people of all ages, races, income
levels, & geographical area
• Headache is a painful and disabling feature ,
and are the most common disorder of the
nervous system.

3. Definition
• A headache is a pain or discomfort in the
head, scalp, or neck. The major types are
– Primary Headache
– Secondary Headache

4. Primary Headache
• A primary headache is due to the headache
condition itself and not due to another
cause. Types of primary headache are
• Migraine
• Tension Type
• Cluster
• Other types

5. MIGRAINE HEADACHE
• Considered as vascular 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

6. Types
• Common migraine: it has no "aura.” About 80% of migraines are
common.
• Classic migraines (migraine with aura): it present with an aura before
the headache and are more severe than common migraines.
• A silent or acephalgic migraine: it is a migraine without head pain but
with aura and other aspects of migraine.
• A hemiplegic migraine: This can have symptoms that mimic a stroke,
such as weakness on one side of the body, loss of sensation, or feeling
"pins and needles."
• A retinal migraine: Retinal migraine causes temporary vision loss in
one eye, which can last from minutes to months, but it is usually
reversible. This is often a sign of a more serious medical problem, and
patients should seek medical care.
• A chronic migraine: It is a migraine headache that lasts for more than
15 days per month for three consecutive months.
• Status migrainosus: it is a constant migraine attack that lasts more than
72 hours.

7. Etiology
• Hormonal changes in women.
– Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause
– Hormonal medications, such as oral contraceptives and hormone replacement therapy
• Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
• Stress. Stress at work or home can cause migraines.
• Sensory stimuli.
– Bright lights and sun glare can induce migraines, as can loud sounds.
– Strong smells — including perfume, paint thinner, secondhand smoke
• Sleep changes. Missing sleep, getting too much sleep
• Physical factors. Intense physical exertion, including sexual activity, might provoke
migraines.
• Weather changes. Barometric pressure can prompt a migraine.
• Medications. Oral contraceptives and vasodilators, such as nitroglycerin.
• Foods. Aged cheeses and salty and processed foods, skipping meals or fasting.
• Food additives. Sweetener aspartame and the preservative monosodium glutamate
(MSG)

8. Pathophysiology
Presymptomatic hyperexcitabilty increases brain stem response to
triggers
Release of Neurotransmitters (5-HT, NE, DA, GABA, Glutamate, NO, CGRP,
Substance P, Estrogen)
Neurotransmitters activate the Trigeminal Nucleus
Activation of
Hypothalamus
(Hypersensitivity)
Activation of
Area Postrema
Activation of
cervical trigeminal
system (Muscle
spasm)
Dilation of
Meningeal
blood vessels
(Throbbing)
Activation of
Cortex and
Thalamus (Head
pain)

9. CLINICAL FEATURES
• Clinical manifestations of migraine headache are
triggered by missing meal, intense stress, thymine
rich food and sleep alteration
– Anorexia,
– Nausea, vomiting,
– Visual disturbances

11. Management
• Vasoconstrictor – sumatriptan
• Triptan nasal spray in pt with nauseaa and
vomiting.
Nursing care
• Should not given in hypertension , ischemic heart
diseases
• Excesss dose can cause tremor

12. TENSION HEADACHE :
• Is the most common type of headache, is
characterized by bilateral location. It is usually
mild or moderate intensity and not aggravated by
physical activity. Tension type headache is sub
categorize as
– Infrequent episodic
– Frequent episodic
– Chronic

13. ETIOLOGY
• It caused due to sustained pain full contraction of the
muscles of the scalps and neck
• Physical or emotional stress
• Alcohol use
• Caffeine (too much or withdrawal)
• Colds, the flu, or a sinus infection
• Dental problems such as jaw clenching or teeth grinding
• Eye strain
• Excessive smoking
• Fatigue or overexertion

14. Clinical manifestation
• The headache pain may be described as:
• Dull, pressure-like (not throbbing)
• A tight band or vise on or around the
head
• All over (not just in one point or one
side)
• Worse in the scalp, temples, or back of
the neck, and possibly in the shoulders
• The pain may occur once, constantly, or
daily.
• Pain may last for 30 minutes to 7 days. It
may be triggered by or get worse with
stress, fatigue, noise, or glare.
• There may be difficulty sleeping.
• People with tension headaches
try to relieve pain by massaging
their scalp, temples, or the
bottom of the neck.
• Sleep disturbances
• Photophobia – sensitivity to
light
• Phonophobia – sensitivity to
sound

15. Management
• Over-the-counter (OTC) pain medicines,
such as aspirin, ibuprofen, or
acetaminophen
• Narcotic pain relievers are generally not
recommended
• Muscle relaxers
• Tricyclic antidepressants to prevent
recurrences

16. Health Education
• Keep warm if the headache is associated with
cold.
• Use a different pillow or change sleeping
positions.
• Practice good posture when reading, working,
or doing other activities.
• Exercise the neck and shoulders frequently
when working on computers or doing other
close work.
• Get plenty of sleep and rest.

17. Secondary Headache
• A secondary headache is present because of
another condition. The management of
secondary headache focuses on diagnosis
and treatment of the underlying condition.
The types of secondary headache are
• Systemic infection E.g. Meningitis,
• Head injury
• Vascular disorders E.g. Aneurysm Rupture, Stroke
• Subarachnoid hemorrhage
• Brain tumor

18. CLUSTER HEADACHE:
• A cluster headache commonly awakens you in the
middle of the night with intense pain in or around
one eye on one side of your head. Bouts of
frequent attacks, known as cluster periods, can
last from weeks to months, usually followed by
remission periods when the headaches stop

19. Types
• There are two types of cluster headaches:
episodic and chronic.
• Episodic cluster headaches occur regularly
between one week and one year, followed by a
headache-free period of one month or more.
• Chronic cluster headaches occur regularly for
longer than one year, followed by a headache
free period that lasts for less than one month.

20. Etiology
• Exact cause is unknown
• Sudden release of histamine, serotonin
• Hypothalamic issues
• Others
– Alcohol and cigarette smoking
– High altitudes (trekking and air travel)
– Bright light (including sunlight)
– Exertion (physical activity)
– Heat (hot weather or hot baths)
– Foods high in nitrites (bacon and preserved meats)
– Certain medicines
– Cocaine

21. Clinical manifestation
• Excruciating pain that is generally situated in, behind or
around one eye, but may radiate to other areas of face,
head and neck
• One-sided pain
• Restlessness
• Excessive tearing
• Redness of your eye on the affected side
• Stuffy or runny nose on the affected side
• Forehead or facial sweating on the affected side
• Pale skin (pallor) or flushing on your face
• Swelling around your eye on the affected side
• Drooping eyelid on the affected side

22. Medication
• Pain medication relieves your headache pain once it has begun.
Treatments include:
• Oxygen: Breathing 100-percent pure oxygen when the headache
begins can help relieve symptoms.
• Triptan medications: A nasal spray medication called
sumatriptan (Imitrex), or other tripitan medications constrict
blood vessels, which can help ease your headache.
• DHE: An injected medication called dihydroergotamine (DHE),
can often relieve cluster headache pain within five minutes of
use. Note: DHE can’t be taken with sumatriptan.
• Capsaicin cream: Topical capsaicin cream can be applied to the
painful area.

23. • Blood pressure medications, such as propranolol or
verapamil which relax your blood vessels
• Steroid medications, such as prednisone, which
reduce nerve inflammation
• A medication called ergotamine that keeps your
blood vessels from dilating
• Antidepressant medications
• Anti-seizure medications, such as topiramate and
valproic acid
• Lithium carbonate
• Muscle relaxants, such as baclofen

24. Surgery
• As a last resort, a surgical procedure can be
used to disable the trigeminal nerve.

25. Risk factors
• Sex. Men are more likely to have cluster headaches.
• Age. Most people who develop cluster headaches are
between ages 20 and 50, although the condition can
develop at any age.
• Smoking. Many people who get cluster headache
attacks are smokers. However, quitting smoking
usually has no effect on the headaches.
• Alcohol use. If you have cluster headaches, drinking
alcohol during a cluster period may increase your
risk of an attack.
• A family history. Having a parent or sibling who has
had cluster headache might increase your risk.

26. LUMBAR PUNCTURE HEADACHE
• Headache after Lumbar puncture. Occurs within
48 hrs but delayed up to 12 hrs.
• Begins when the client sits or stand upright .
• Reduction with abdominal compression, worsened
with headshaking.

28. DIAGNOSTIC TESTS :
• History taking
• Physical examination
• Electromyography ( EMG ) = this test may reveals
the sustained contractions of the muscles of the
neck , face & scalp

29. Nursing management
• Help to identify the stressful stimuli and learn
to cope with that.
• Daily exercise, relaxation and socialization.
• Encourage to avoid beverages
• Massage and moist heat on head to reduce
tension headache .
• Patient should avoid smoking
• Provide quite dim light
• Comfort measures and stress reduction
technique.

30. THANK YOU