Headache

Question 1

What are the types of headache available?

Answer 1

1. Migraine
2. Tension-type headache
3. Cluster headache
4. Intracranial mass lesion
5. Low ICP state
6. Meningitis/SAH
7. Temporal arteritis/intracranial vasculitis

Question 2

What is a migraine?

Answer 2

Neurally induced inflammation and dilatation of intracranial and extracranial vessels

Question 3

How long does a migraine lasts?

Answer 3

4-72hrs

Question 4

What are the pain characteristics for migraine?

Answer 4

1. Often unilateral but can be bilateral
2. Throbbing/pulsating pain

Question 5

What intensity of pain does migraine have?

Answer 5

Moderate to severe (often debilitating)

Question 6

What are the signs and symptoms of migraine?

Answer 6

1. Nausea
2. Vomiting
3. Photophobia
4. Phonophobia
5. Aura/visual disturbances before migraine
   (Flashing lights, zig zag/temp loss of vision)

Question 7

What is a common migraine?

Answer 7

A migraine without aura

Question 8

What is the criteria to diagnose a common migraine?

Answer 8

At least 5 attacks that fulfil the following criteria:
- each attack, either successful/unsuccessful, lasts for 4-72hrs

An attack has at least 2 of the following characteristics
1. Unilateral location
2. Pulsating quality
3. Moderate to severe intensity
4. Pain aggravated by exertion/routine physical activity

During an attack, at least one of the following symptom must be present:
1. Nausea
2. Vomiting
3. Photophobia
4. Phonophobia

+ No evidence from hx/PE of any other disease that might cause headaches

Question 9

What is a classic migraine?

Answer 9

A migraine with aura

Question 10

What is the incidence for classic migraine?

Answer 10

15%

Question 11

How often do aura accompany migraine in a classic headache?

Answer 11

A few, most/all attacks

Question 12

How long does an aura last for for classic migraine?

Answer 12

20-60mins
(*some may trespass first few minutes of a headache and mostly are visual)

Question 13

What is the criteria for diagnosing classic migraine?

Answer 13

At least 5 attacks with the following criteria:
- each attack, whether successfully treated or not, lasts for 4-72hrs

Attack has at least 2 of the following characteristics:
1. Unilateral location
2. Pulsating quality
3. Moderate to severe intensity
4. Pain that aggravates upon exertion/routine physical activity

During the attack, at least one of the following symptoms must be present
1. Nausea
2. Vomiting
3. Photophobia
4. Phonophobia

+ no evidence from hx/PE of any other disease that might cause headaches

+ symptoms of neurological dysfunction b4/during an attack

Question 14

What is a tension-type headache?

Answer 14

It is a headache of an unknown cause, may be an increase in sensitivity to pain-mediating systems in brain

Question 15

How long does a tension-type headache last for?

Answer 15

30min to a few days

Question 16

What are the pain characteristics of tension-type headache?

Answer 16

1. Typically bilateral
2. Steady, pressing/tightening quality - described as a band-like pressure around head

Question 17

What is the intensity of pain for tension-like headache?

Answer 17

Mild to moderate (*not as severe as migraine/cluster headache)

Question 18

What are the signs and symptoms of tension-type headache?

Answer 18

1. Not so pronounced photophobia and Phonophobia
2. Mild tenderness in neck, shoulders and scalp

Question 19

What is a cluster headache?

Answer 19

A neurally induced inflammation and oedema of internal carotid artery

Question 20

How long does a cluster headache lasts for?

Answer 20

15min-3hrs

Question 21

What are the pain characteristics of cluster headache?

Answer 21

1. Severe, excruciating, usually unilateral (focused around one eye/temple)
2. Sharp/burning pain

Question 22

What is the pain intensity of cluster headache?

Answer 22

Extremely severe (*described as most severe headache one could experience)

Question 23

What are the signs and symptoms of cluster headache?

Answer 23

Signs and symptoms are ipsilateral

1. Nasal congestion
2. Rhinorrhoea/runny nose
3. Ptosis (drooping of eyelid)
4. Lacrimation/tearing
5. Agitation
6. Restlessness

Question 24

What is an intracranial mass lesion headache?

Answer 24

It is a headache caused by brain tumor/hydrocephalus

It can be due to displacement/traction of pain-sensitive vessels

Question 25

What is a low ICP state headache?

Answer 25

It can happen post lumbar puncture due to traction through brain sagging on dural attachments/intracranial vasodilation

Question 26

What is the cause of headaches in meningitis/SAH?

Answer 26

Inflammation of vessels in meninges and perivascular dura

Question 27

What is the cause of temporal arteritis/intracranial vasculitis?

Answer 27

Inflammation of scalp and intracranial vessels

Question 28

What is the treatment for headaches?

Answer 28

Treatment for headaches are abortive and symptomatic (relief of headache & associated symptoms)

1. NSAIDS
2. Mixed barbiturate analgesic (aspirin, acetaminophen/caffeine-containing compound)
3. Triptans
4. Antiemetics (promethazine, prochloroperazine, metaclopramide)
5. Cafergot/Ergotamine/Caffeine

Question 29

When should prophylactic treatment be done for headaches?

Answer 29

1. When >/= 2 attacks each month with significant disability that lasts for >/= 3 days
2. When a patient is contraindicated to/ineffectiveness of symptomatic meds
3. When patient uses abortive medications >2x/wk
4. Suffers of migraine variants (hemiplegia migraine/rare headache attacks) producing profound disruption/risk of permanent neurological injury

Question 30

What are the medications used for prophylactic treatment of headache?

Answer 30

1. B-blockers
2. Tricyclic antidepressants (amitriptyline)
3. Ca antagonists (flunarizine/verapamil)
4. NSAIDs
5. Anticonvulsants (valproate)

Question 31

What are the holistic nursing care to give to pt suffering from headaches?

Answer 31

1. Comfort care
2. Pt education
   a) type of headache
   b) headache diary
   c) identify triggers
   d) lifestyle modification
   e) reduce stress and relax
   f) meds