Lecture 4: Headache, Fever and Pain II Flashcards
Primary headache
- Not associated w an underlying illness
- Migraine, Sinus and Tension-Type headache
Migraine
- Complex interaction of neuronal and vascular factors
- Dysfunction of the trigeminovascular system
- Sudden throbbing/ pulsating pain
- Lasts hours to 3 days
Sinus
Infection or blockage of the paranasal sinuses
- Dull bilateral pain, pressure behind eyes/ face
- with sinus symptoms
- Last days
Tension-Type headache
- Underlying cause uncertain
- Episodic vs chronic
- Gradual pain
- Headache, neck pain, tight pressure
- Lasts minutes to days
Headache: Exclusions to Self Care
§ Severe head pain
§ Rapid onset of maximum pain
§ Concerning change in headache pattern
§ First or worst headache
§ Gradual escalation over months
§ Headache that persists for 10 days (+/- treatment)
§ High fever/signs of infection, neck stiffness, neurologic changes
§ Last trimester of pregnancy
§ New headache during pregnancy
§ Age <8 years
§ History of liver disease or consumption of ≥3 alcoholic drinks/day
§ Secondary headache (except for minor sinus headache)
§ Migraine without formal diagnosis
Tension Type Headaches: Non Pharmacologic Therapy
- Physical Therapy
- Relaxation exercises
Migraine Headache: Non Pharmacologic Therapy
- Ice packs combined with pressure
- Regular eating, exercise and sleeping schedules
- Stress management
Sinus Headache: Pharmacologic Therapy
- Acetaminophen, NSAIDS, Aspirin
- Nonprescription analgesics combined with decongestants
Migraine Headache: Pharmacologic therapy
- Medical diagnosis required prior to self care
- NSAIDS, Aspirin
- Nonprescription analgesics taken at headache onset
Episodic Tension Headache: Pharmacologic Therapy
- Acetaminophen, NSAIDS, aspirin
- Nonprescription analgesics taken at headache onset
Fever
- Regulated rise in body temperature in response to a pyrogen
- Most are self-limiting and nonthreatening
- Temperature greater than 100 F
- Caused by response to medication, vigorous activity, infection and pathology
Fever: Exclusions to Self-Care
> 3 mths w rectal temp > or equal too 104 F
- < 3 mths w rectal temp > or equal to 100.4 F
- Older than 2 yrs w fever that last longer than 3 days
- Younger than 2 yrs old w fever that last longer than 24 hours
- Children who develop spots or rash, refuse to drink fluids or are vomiting and cannot keep down fluids, are very sleepy/ hard to wake, repeated diarrhea, history of seizures, stiff neck
- Fever that repeatedly rises above 104 oF (40 oC)
- Severe symptoms of infection that are not self-limiting
- Risk for hyperthermia
- Impaired oxygen utilization
- Impaired immune function
- Central nervous system (CNS) damage
Goals of Self-treatment
- Alleviate discomfort
Adequate hydration
Non-Pharm- Children increase intake by 30-60mL per hour
-Adult increase intake by 60-120mL per hour - removing clothes and light blanket
Pharm- Nonprescription antipyretics
§ Acetaminophen, NSAIDs, aspirin
Musculoskeletal Pain
- Pain in bones, connective tissues, joints and muscles
Complaints result in increased use of health care system, lost
work days, other limitations, and loss of employment
Musculoskeletal Pain: Exclusions to Self Care
§ Severe pain (pain score >6)
§ Pain that lasts >10 days
§ Pain that continues >7 days after treatment with a topical analgesic
§ Increased intensity or change in character of pain
§ Pelvic or abdominal pain (other than dysmenorrhea)
§ Accompanying nausea, vomiting, fever, or other signs of systemic
infection or disorder
§ Visually deformed joint, abnormal movement, weakness in any limb,
numbness, or suspected fracture
§ Pregnancy
§ <2 years of age
§ Back pain and loss of bowel and/or bladder control
Musculoskeletal Pain: Non Pharmacologic Therapy
§Prevention
§ Adequate hydration, appropriate footwear, stretching/warming up
- RICE therapy Rest area until pain reduced Ice for 15-20 mins 3-4 times/day Compression with elastic support Elevate for 2-3 hours
- Heat therapy apply for 15-20 mins, 3-4 times per day
- Proper posture and ergonic controls
Musculoskeletal Pain: Goals of Self treatment
- Decrease subjective intensity/severity of pain
- Decrease duration of pain
- Restore function of affected area
- Prevent re-injury and disability
- Prevent acute pain from becoming chronic persistent pain
Secondary Headache
§ Symptoms of an underlying condition
Migraine Symptoms
Headache, Nausea
Migraine Characteristics
Throbbing/pulsating,
may be preceded by
aura
Migraine Onset
Sudden
Migraine Location
Usually unilateral
Migraine Duration
Hours to three days
Sinus Symptoms
Headache,
nasal congestion
Sinus Characteristics
Dull bilateral pain,
pressure behind
eyes/face
Sinus Onset
With sinus symptoms
Sinus Location
Face, forehead,
periorbital area
Sinus Duration
Days
Tension-Type Symptoms
Headache, neck pain,
scalp tenderness
Tension-Type Characteristics
Diffuse ache, tight
pressure, constricting
pain
Tension-Type Onset
Gradual
Tension-Type Location
Bilateral, top of head
to base of skull
Tension-Type Duration
Minutes to days
Headache: Goals of Self-Treatment
- Reduce severity and alleviate acute pain
- Restore normal functioning
- Prevent relapse
- Minimize adverse effects
- Reduce frequency of chronic headaches
Headache: Patient Education
§ Take appropriate analgesic dose early in course of headache
§ Trigger avoidance
Headache: Evaluation of Patient Outcomes
§ Follow-up depends on frequency and severity
§ Refer if persists >10 days or worsens
Fever: Pathophysiology
- Defined as core temperature greater than 100 oF (37.8 oC)
- Increases in thermoregulatory “set point” may be
- Idiopathic
Fever may be caused by:
§ Infection
§ Pathology
§ Response to medication
§ Vigorous activity
Fever: Complications
Major risks are rare, but may include:
§ Dehydration
§ Mental status changes
§ Seizures
Fever: Clinical Presentation
§Symptoms are often nonspecific § Most important sign is elevated temperature § Associated signs/symptoms § Anorexia § Arthralgia § Chills § Diaphoresis § Generalized malaise § Headache § Irritability § Myalgia § Tachycardia
Fever: Detection
Considerations § Age § Anatomical site § Environmental temperature § Level of physical/emotional stress § Time of day
Routes § Axillary § Oral § Rectal § Temporal § Tympanic
Fever: Patient Education
§ Treatment should focus on primary cause
§ Take temperature with an appropriate thermometer
§ Pharmacologic therapy may take up to 1 day to result in a core
temperature decrease
§ Alternating antipyretics is not recommended
Fever: Evaluation of Outcomes
§ Monitor temperature and discomfort
§ Refer if persists >3 days (>24 hours if <2 years)
Musculoskeletal Pain Acute
§ Pain lasting <4 weeks
§ Examples: exacerbation of a condition, sports injuries
Musculoskeletal Pain Chronic
§ Pain lasting at least 3 months
§ Examples: carpal tunnel, degenerative joint disease, osteoarthritis
Myalgia Symptoms
Pain, muscle
weakness/fatigue,
possible edema
Myalgia Characteristics
Dull, constant ache
Myalgia Onset
Varies depending on
cause
Myalgia Location
Muscles
Osteoarthritis Symptoms
Localized pain, joint
stiffness, possible edema
Osteoarthritis Characteristics
Dull joint pain
Osteoarthritis Onset
Development over years
Osteoarthritis Location
Weight-bearing joints
Sprain/Strain Symptoms
Pain, tenderness, loss of
function, edema, bruising
Sprain/Strain Characteristics
Initial severe pain,
continued pain especially
with use
Sprain/Strain Onset
Acute with injury
Sprain/Strain Location
Ligaments/tendons
Musculoskeletal Pain: Pharmacologic Therapy
§Initial treatment § Systemic nonprescription analgesics § Acetaminophen, NSAIDs §Adjunct therapy § Topical analgesics
Musculoskeletal Pain Patient Education
§ Early analgesic administration recommended for acute pain
§ Preventative measures
Musculoskeletal Pain Evaluation of Outcomes
§ Patient’s perception of pain relief
§ Refer if persists >10 days or worsens/changes
