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Headache

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10 views35 pages

Headache

Uploaded by

koreamydream85
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HEADACHE

What you need to know

Age Adult, child

Duration

Nature and site of pain

Frequency and timing

Previous history Fits, faints, blackouts and


migraine
Associated symptoms (Nausea, vomiting and
photophobia )

Precipitating factors (Foods, alcohol, stress and


hormonal)

Recent trauma or injury

Falls
Migraine
The peak onset for a person to have their first attack is
in adolescence or as a young adult. Migraines are
rare over the age of 50 and anyone in this age group
presenting for the first time with migraine-like symptoms
should be referred
There are two common types of migraine:
Migraine with aura is often associated with alterations in
vision before an attack starts the so-called prodromal
phase.
migraine without aura, there is no prodromal phase
Women who get migraine with aura, or particularly
severe migraine without aura, should not take the
combined contraceptive pill, patch or ring, because
of an increased risk of stroke.
International Headache Society’s
diagnostic pointers for migraine
Migraine without aura (common migraine)

Headache has at least two of the following four


characteristics

1.Unilateral location

2. Pulsating quality

3. Moderate or severe pain intensity

4. Aggravation by, or causing avoidance of, routine


physical activity
During headache at least one of the following
symptoms:

1. Nausea and/or vomiting

2. Photophobia (aversion to light) and phonophobia


(aversion to noise)
Migraine with aura (classic migraine) One or more of
the following fully reversible aura symptoms:

1. Visual

2. Sensory

3. Speech and/or language

4. Motor

5. Brainstem

6. Retinal
At least two of the following four characteristics:

1. At least one aura symptom spreads gradually


over≥5 min, and/or two or more symptoms occur in
succession.

2. Each individual aura symptom lasts 5–60 min.

3. At least one aura symptom is unilateral.

4. The aura is accompanied, or followed within 60


min, by headache.
Tension-type headache
These headaches are most often related to upset or
stress.

recurrent episodes of headache that are usually bilateral


and have a pressing or tightening quality (non-pulsating)
that is mild to moderate in intensity.

is not aggravated by routine physical activity such as


walking or climbing stairs and

is not associated with nausea or vomiting or


photophobia or phonophobia
Chronic tension-type
headache
The term chronic tension-type headache is used if the headache
occurs on 15 days or more per month, on average, and lasts for
more than 3 months at a time

These types of headache are usually seen in adults (mean age


of 40 years), but they are also sometimes seen in children and in
the very old.

In some cases, it is possible that frequent use of simple


analgesics, migraine treatments or combinations containing
codeine are causing or aggravating chronic headache.

Any frequent headache needs referral to the GP surgery for


assessment.
Medication overuse
headache
Develops or worsens with frequent use of any drug treatment for
pain in people who have tension-type headache or migraine.

It has also been identified in people taking analgesics for other


painful conditions.

It is most commonly seen when triptans, opioids, ergots or


combination analgesia have been taken for 10 days per month or
more and is sometimes seen if paracetamol, aspirin or NSAID
taken on 15 days per month or more.

The main treatment is stopping the analgesia, with careful support


and encouragement. It may take 2 months to resolve.
Cluster headaches
(migrainous neuralgia)
A typical pattern would be daily episodes of pain over 2–3
months, after which there is a remission for anything up to 2
years.
In typical cases the headache commonly wakes the person
from sleep within 2 hr of going to sleep
Each episode of pain can last from 15 min to 3h,and the pain
is usually experienced on one side of the head
It is often accompanied by a painful, watering eye and a
watering or blocked nostril on the same side as the pain
It requires referral as sumatriptan which is the DOC should be
given by prescription.
Sinusitis

Sinusitis may complicate a respiratory viral infection (e.g.


cold) or allergy (e.g. hay fever), which causes inflammation
and swelling of the mucosal lining of the sinuses
The pain may be felt behind and around the eye, or over the
cheek, with radiation over the forehead and often only one
side is affected.
It is typically worse on bending forwards or lying down, the
pain is dull in nature.
A course of decongestants could be tried but if treatment
failure occurs referral to the GP for possible antibiotic therapy
would be needed.
Temporal arteritis

Usually occurs in people over the age of 60 when the


arteries that run through the temples become inflamed.

However only about a half of patients have scalp


tenderness, and these signs are not always present.

should be referred immediately as damage to the retinal


blood supply can cause blindness

It is a curable disease,if diagnosis is made early.

Treatment usually involves high-dose oral corticosteroids.


When to refer

Headache associated with injury/trauma because bruising


or haemorrhage mayoccur,causing arise in intracranial
pressure.

Headache associated with high temperature (>38◦C)

Severe headache of more than 4 h duration

Suspected adverse drug reaction

Headache in children under 12 years

Severe occipital headache (across the back of the head)


Headache that is worse in the morning and then
improves

Associated drowsiness, unsteadiness, visual


disturbances or vomiting

Neck stiffness

Frequent migraines suggesting need for


prophylactic treatment

Frequent and persistent headaches


If the headache does not respond to OTC
analgesics within a day, referral is advisable.
MANAGEMENT
Paracetamol

Has analgesic and antipyretic


effects but little or no anti
inflammatory action.

It is less irritating to the stomach

can be given to children from 2 to


3 months old

effectiveness in the management


of migraine is limited.

Can cause liver toxicity in


overdose
Ibuprofen

has analgesic, anti-


inflammatory and antipyretic
activities

causes less irritation and


damage to the stomach than
does aspirin.

Dose for analgesic activity is


200–400 mg and that for
anti-inflammatory action
300–600 mg.
Ibuprofen

The maximum daily dose


allowable for OTC use is
1200 mg

Ibuprofen tablets or
capsules should not be
given to children under 12
years.

Ibuprofen suspension 100


mg in 5 ml is available
OTC
Ibuprofen, like other NSAIDs,can be irritating to the
stomach,causing indigestion, nausea and
diarrhoea

GI bleeding can also occur

This bleeding effect is reversible within 24 h of


stopping the drug.

Ibuprofen seems to have little or no effect on whole


blood clotting or prothrombin time,but it is still not
advised for patients taking anticoagulant
medication
best avoided in patients with congestive heart
failure or renal impairment.

They should be avoided in pregnancy, particularly


during the third trimester.

Breastfeeding mothers may safely take ibuprofen

Drug interaction with lithium.

NSAIDs are best avoided in aspirin-sensitive


patients and should be used with caution in people
with asthma.
Aspirin
Aspirin is analgesic, antipyretic and
also anti-inflammatory if given in
doses of 600–900mg three to four
times daily.

It should not be given to children


under 16 years

It should not be used for gout or


where there is history of gout.

Cause Gastric irritation

can cause GI bleeding and


hypersensitivity

Not recommended during pregnancy


Codeine & Dihydrocodeine
narcotic analgesic

commonlyfoundincombination
products with aspirin,
paracetamol or both

Constipation is a well
recognised side effect

should only be used in children


over 12 years old

Codeine should also not be


used by breastfeeding mothers
CAFFEINE
• IS INCLUDED IN SOME
COMBINATION ANALGESIC
PRODUCTS TO PRODUCE
WAKEFULNESS AND
INCREASED MENTAL ACTIVITY.
• BEST AVOIDED NEAR BEDTIME
BECAUSE OF THEIR
STIMULANT AND DIURETIC
EFFECT.
• INCREASES THE
EFFECTIVENESS OF
ANALGESICS
Sumatriptan
A selective serotonin receptor
agonists. It works by narrowing
blood vessels in the head, stopping
pain signals from being sent to the
brain, and blocking the release of
certain natural substances that
cause pain, nausea, and other
symptoms of migraine.

50 mg tablets can be used OTC for


acute relief of migraine with or
without aura

used by people aged between 18


and 65 years
A 50 mg tablet is taken as soon as possible after the migraine
headache starts.

A second dose can be taken at least 2 h after the first if


symptoms come back.

A second dose should be taken only if the headache


responded to the first dose.
Caution

People with three or more of the following


cardiovascular risk factors are not suitable for OTC
sumatriptan:

Men aged over 40 years

post-menopausal women

people with hypercholesterolemia

Regular smokers (10 or more daily)


Obese people with body mass index of more than
30 kg/m2

Those with diabetes; or those with a family history


of early heart disease

Either father or brother had a heart attack or


angina before the age of 55 years or mother or
sister had a heart attack or angina before the age
of 65 years.
Contraindication

People with known hypertension

Previous myocardial infarction

Ischemic heart disease, peripheral vascular disease

Coronary vasospasm/Prinzmetal’s angina, cardiac


arrhythmias (including Wolff–Parkinson–White syndrome)

Hepatic or renal impairment

Epilepsy,a history of seizures and cerebrovascular accident


or transient ischemic attack.

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