Define heachae, classification management

1. HEADACHES
Mrs. Safoora Qureshi
Nursing Instructor
CON
PIMS
Islamabad

2.  HEADACHES:
• Headache probably the most common type of pain that humans
experience
• Most common type of functional headaches are
• Tension –type headache or Migraine
• Pain sources:
• Intracranial
• Extra cranial
• Pain sensitive Structure in head
• Venous sinuses,dura,cranial blood vessels
• Trigeminal nerves
• Cranial, facial, glossopharyngeal, vagus, and cervical nerves

4. Classification of headaches (IHS)
Primary
headaches
Secondary
headache
Tension-type
headache
Migraine
headache
Cluster
headache
episodic chronic
Without
aura
(Common
Migraine)
With aura
(Classical
Migraine)

5. Types of Headaches

6. Primary Headaches:
• Not caused by a disease or
another medical condition
• Classified as;
• Tension – type headache
• Migraine headache
• Cluster headaches
Secondary Headaches:
• Caused by another condition or
disorder such as;
• Sinus infection
• Neck injury
• Stroke
• Brain tumors

7.  Tension-Type Headaches:
• Is the most common type of
headache
• Also called stress headache
• Characterized by:
• Locate bilaterally
• Pressing or tightening quality
• Mild to moderate intensity
• Last for minutes to days
• Cyclic frequency for years
Clinical Manifestation
• Bilateral frontal-occipital headache
• Constant, dull pressure or bandlike
• cervical and neck muscles tone
• Photophobia & phonophobia
• Not involve nausea & vomiting
• No prodromal stage
• Not aggravated by physical activity
• Intermittently occurs for weeks,
month and years

8. Etiology and Pathophysiology
Tension-type headache; is the result of
• Sustained and painful contraction of
muscles of the scalp and neck
• Neuromuscular factors:
Changes in blood flow causes
thrombin pain such as;
• Vasocontraction
• Vasodilatation

9. Diagnosis:
• History:
• The most important tool for diagnosis of tension-type headache
• Physical Examination:
• Increased resistance to passive movement of head & tenderness of
head & neck
• Electromyography (EMG):
• A procedure to assess the health of muscles and the nerve cells that
control them (motor neurons).
• Reveals sustained contractions of neck, scalp, or facial muscles

11.  Migraine Headache:
• Migraine is a neurologic disorder that often causes a strong headache
on one side of the head.
Characterized by
Severe throbbing pain or a pulsing sensation,
• often accompanied by nausea and vomiting
• Extreme sensitivity to light and sound.
• Migraine attacks can last for hours to days
• Pain interferes with daily life activities.
• Last for 4 --- 72 hrs or days
• No cure, but prophylactic & symptomatic treatment helps to relive
the symptoms

12. Prevalence:
• By puberty more common in
girls
• More common in women than
men
• Most commonly occurs at 20
to 30 years of age
• Peaks for men and women
between 25 and 55 years
Risk Factors:
• Family history
• Illiteracy
• Low socio-economic status
• High work load
• Frequent tension-type
headaches

13. Etiology and Pathophysiology/(Migraine)
• Vascular theory suggested:
• Vasoconstriction followed by vasodilatation, with resulting changes in blood
flow causes thrombin pain
• A second theory proposes:
• Pain is the result of muscular tension
(tension-type headache)
• Third theory relates:
• Biochemical Changes causes pain such as;
Changes in serotonin pathway result in the headache

14. Causes of migraine:
• Exact causes are unknown
• Neurovascular event
• Family history
• Seizures disorders
• Ischemia, stroke
• Depression, anxiety
• Asthma
• Myocardial infarction
• Irritable bowel syndrome (IBS)

15. Precipitating Factors (migraine)
• Caffeine withdrawal
• Hormonal changes during
• menstrual cycle
• use of birth control pills
• Sleep disturbance, such as not getting enough sleep
• Drinking alcohol
• Smoking or exposure to smoke
• Exercise or physical stress
• Loud noises or bright lights
• Missed meals
• Odors or perfumes
• Stress and anxiety
• Weather
• Foods such as chocolate, cheese, oranges, o

16. Clinical manifestation (migraine):
• Preceded by a prodrome and an aura
• Pain Pounding or throbbing in nature
• Usually unilateral but can be bilateral
• Discomfort with lights (photophobia)
• Discomfort with loud noises (phonophobia)
• With or without aura
• Neurological dysfunction
• visual disturbance, bright lights,, zigzag lines
• Being sensitive to light, sound, or smell
• GIT disturbance
• Nausea vomiting
• Bloating, constipation, or diarrhea
• Nausea and vomiting

18. Treatment of Migraine:
• No cure for migraines, but prophylactic and symptomatic
therapies are available to reduce the symptoms.
• Painkillers -- nonopioids
• Paracetamol or ibuprofen
• Triptans – helps to reverse the changes in the brain that may
cause migraines
• Sedatives
• Muscles relaxants
• Anti-emetics – relieve feeling of sickness (nausea)
• Sleeping or lying in a darkened room
• Prevent exposure to triggers

19.  Cluster Headaches:
• One of the severe type of pain
• Sharp stabbing in nature
• Pain located around eye
• Lacrimation, facial flushing or pallor, and rhinitis
• Agitations and restlessness
• Attacks occurs in cluster 1--- 3 times a day, over a period of
4---8wks
Duration 30---- 90/minutes
• More common in men and tend to start 30s or 40s.
• Causes mid-night awakens with intense pain in or around one eye on one
side of the head.

20. Etiology and Pathophysiology:
 Causes: are unknown
 Pathological mechanism: is not fully under stood
• Trigeminal nerve play a role in producing of pain
• Hypothalamus activation
• Disturbance of “Biological Clock”
• Dysfunction of;
• intracranial blood vessels / “aneurysm”
• Sympathetic nervous system
• Pain modulation system
 Triggers:
• Alcohol is the only dietary triggers
• Cigarette smoke, Strong smells
• Weather change/allergies
• Exercise or exertion

21. Collaborative care for headaches
Tension-Type Headache Migraine Headache Cluster
Diagnostic • History
Neck,& head tenderness
Resistance to movement
• History • History
Collaborative Therapy
• Symptomatic Drugs
• Nonopioid analgesic
Aspirin, ibuprofen
Acetaminophen
• Muscles relaxants
• sedatives
• Nonopioid analgesic
Aspirin, ibuprofen
Acetaminophen( Panadol)
• Serotonin receptors
agonist (Triptans)
• Anti-emetics
• Alpha-adrenergic blockers
• Corticosteroids
(dexamethasone)
• Alpha-adrenergic
blockers
• Vasoconstrictors
• NSAIDs
• Oxygen 100 %
• Prophylactic Drugs • Tricyclic Antidepressants
• Beta-adrenergic blockers
( propranolol)
• Biofeedback
• Psychotherapy
• Relaxation techniques
• Prevent exposure to triggers
• Antidepressants
(imipramine)
• Calcium channels blockers
• Relaxation therapy
• Cognitive-behavioral
therapy
• Alpha-adrenergic
blockers
• Corticosteroids
(prednisolone)
• Lithium
• Biofeedback