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INTRODUCTION

CASE

The patient is a 26-year-old woman who complains of stress headaches. For the 4th time

since last week, she develops a mild left-sided neck tightness that, after several hours, spreads to

the left temporal area with moderate intensity. She is easily irritated by her officemate's loud

chatter, squints on headlights, and feels a left-hand weakness as she drives home by 5 pm. Her

headaches last about 5 hours and are minimally reduced by Acetaminophen. Today, her headache

was accompanied by nasal congestion, prompting V to head on to the pharmacy for a quick consult.

The patient denies allergies to food and medications and currently takes Rosuvastatin 5mg

for her hypertriglyceridemia.

OBJECTIVES

1. To discuss headaches and how it affects the different organ systems.

2. Discuss the symptoms of the patient based on the pathophysiology of the disease presented

in the case.

3. Discuss the diagnostic procedures related to the case.

4. Discuss the possible medication or treatments for the patient.

5. And, lastly, to discuss the preventive measures (including management of headaches).

HEADACHE

A headache is a pain or discomfort in the head or face area. Types of headaches

include migraine, tension, and cluster. Headaches can be primary or secondary. If it is

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secondary, it is caused by another condition. It can be acquired by anyone but most

commonly affects adults.

Classification of Headaches

• Primary Headache

• Tension-type headache

Tension-type headache (TTH) is the most common neurological condition in the

world, with symptoms including recurrent headaches of mild to moderate intensity,

bilateral location, pressing or tightening quality, and no aggravation by ordinary

physical activity. (Ashina et al., 2021).

• Migraine headache

Migraine is a common primary, although clearly not exclusively, headache disorder

characterized by recurrent episodes of headache often associated with nausea,

vomiting, photophobia, and phonophobia (Yeh et al., 2018).

• Trigeminal autonomic cephalalgias

TAC is a group of relatively rare primary headache disorders characterized by

moderate to severe, short-lived head pain in the trigeminal distribution with

unilateral cranial parasympathetic autonomic features, such as lacrimation,

rhinorrhea, conjunctival injection, eyelid edema, and ptosis. (Ravishankar, 2018).

• Secondary Headache

• Trauma or injury to the head/neck

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An accident or recent trauma injury around the area of the head or neck may have

caused a headache.

• Cranial or cervical vascular disorder

Headache can present as an accompanying symptom of major cerebrovascular

disease. Such a headache could have a sudden onset reminiscent of a thunderclap

or may progress gradually over several days. (Jafari, 2022).

• Non-vascular intracranial disorder

Some of these headache disorders are caused by high or low cerebrospinal fluid

pressure; noninfectious inflammatory diseases such as neurosarcoidosis, aseptic

(noninfectious) meningitis, and lymphocytic hypophysitis; or intracranial

neoplasm. (Obermann et. al., n.d.).

• Substance use or withdrawal

Medication-overuse headache (MOH) is a common neurologic disorder with

enormous disability and suffering and plays a significant role in the transformation

from episodic to chronic headache disorders. (Fischer & Jan, 2019).

• Infection

Headache may be a symptom of another infection that the body has.

Types of Headache

• Sinus - Pain is behind the brow bone or cheekbones.

• Cluster - Pain is in and around one eye.

• Tension - Pain is like a band squeezing the head.

• Migraine - Pain is often on one side of your head.

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SYMPTOMS

Headaches result from the signals interacting in your brain. Any mechanism or activity

may trigger a particular nerve that influences the muscles and blood vessels. Your brain receives

pain signals from these nerves, which results in headaches.

The symptoms of a headache are the ff:

• Vision changes (blurry vision, double vision, or blind spots)

• Personality changes/inappropriate behavior

• Sudden loss of balance or falling

• Numbness or tingling

• Mental confusion

• Weakness

• Dizziness

• Paralysis

• Seizures

RISK FACTORS

Other researchers still finding what causes a headache but these are the risk factors to have a

headache:

1. Stress

2. Lack of sleep

3. Missing meals

4. Overuse of caffeine
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5. Eye strain

6. Drinking alcohol

7. Smoking

8. Spending too much time on screens

9. Physical overexertion

10. Exposure to bright lights

11. Heat

12. Weather changes

Possible medication or treatments for the patient

Some headache drugs are available off the shelf at the pharmacy. These medicines are

referred to as over-the-counter (OTC) analgesics. With other headache treatments, a prescription

from a doctor is required. The ideal medication for your needs can be determined with the

assistance of your doctor.

a. Over-the-counter medications such as:

1. Ibuprofen (Advil, Motrin IB, others)

2. Acetaminophen (Tylenol, others)

3. Aspirin

b. Prescription medications such as:

1. Triptans

2. Sumatriptan (Imitrex)

3. Zolmitriptan (Zomig)
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METHODOLOGY

DATA COLLECTION

To collect the needed data, the researchers conducted an interview with the patient to

discuss the important details of her condition. The interview questionnaire used a semi-structured

style to keep the patient comfortable.

ETHICAL CONSIDERATIONS

As per the patient’s request, her identity shall remain confidential throughout this study.

All data presented in this study shall not be used in an unethical manner. The researchers also made

sure that every process of the study where the patient is needed will be conducted with their

consent.

DIAGNOSTIC PROCEDURE

The researcher needs to check the following to assess the condition of the patient:

1. Age

2. Duration

3. Nature and site of pain

4. Frequency and timing of symptoms

5. Previous history

6. Associated symptoms

7. Precipitating factors
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8. Recent trauma or injury

9. Falls
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RESULTS

According to the symptoms described by the patient, the type of headache she experienced

was Migraine Headache with Aura. Because the patient was easily irritated by her officemate's

loud chatter, which is a sign of phonophobia; also, the patient's headache occurs for about 5 hours

and only on the left side of his head; and lastly, the patient squints in the headlight, indicating that

the patient is photophobic.

CONCLUSION

Headaches are a common type of pain experienced by humans all over the world, it can be

classified into two types: primary and secondary. It has four types which are sinus, migraine,

cluster, and tension. There are many risk factors involving this disorder that can cause headaches

and start to show symptoms. The easiest and most convenient way to relieve headaches is a pain

reliever or much better the doctor's prescription medicine to the patient. The data was obtained

through an interview and the patient wants to keep her identity hidden throughout the study.

According to the symptoms presented in the case and different methods of data collection, it can

be concluded that the patient may be experiencing a Migraine Headache and showcase

phonophobia and photophobia as side effect.

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RECOMMENDATIONS

MANAGEMENT STRATEGIES

The researchers recommend the following to manage and prevent the headaches of the patient:

• Pharmacologic

• Over-the-counter medications

1. Paracetamol - is a commonly used medicine that can help treat pain and reduce a high

temperature (fever). It's typically used to relieve mild or moderate pain.

2. Ibuprofen (Advil, Motrin IB, others) - is a nonsteroidal anti-inflammatory drug (NSAID).

It works by reducing hormones that cause inflammation and pain in the body.

3. Acetaminophen (Tylenol, others) - is used to treat fever and mild to moderate pain.

4. Aspirin - it is also known as acetylsalicylic acid, is a nonsteroidal anti-inflammatory drug

used to reduce pain, fever, and/or inflammation, and as an antithrombotic.

b. Prescription medications

1. Triptans - is a family of tryptamine-based drugs used as abortive medication in the

treatment of migraines and cluster headaches.

2. Sumatriptan (Imitrex) - is used to treat migraine headaches and cluster headaches. It is

taken orally, intranasally, or by subcutaneous injection.

3. Zolmitriptan (Zomig) - is a triptan used in the acute treatment of migraine attacks with or

without aura and cluster headaches.

• Nonpharmacologic

1. Develop a stress-management technique.

2. Apply pressure to the head or temples using ice packs.

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3. Moderate exercise three to five times each week for 30 minutes will help reduce stress.

4. Relaxation may help reduce headaches.

5. Eat healthy food like fruits and vegetables.

6. Maintain a regular sleep schedule.

7. Drink lots of water

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LITERATURE CITED

Ashina, S., Mitsikostas, D. D., Lee, M. J., Yamani, N., Wang, S. J., Messina, R., Ashina, H., Buse,

D. C., Pozo-Rosich, P., Jensen, R. H., Diener, H. C., & Lipton, R. B. (2021). Tension-type

headache. Nature Reviews Disease Primers Volume, 7.

https://doi.org/https://www.nature.com/articles/s41572-021-00257-

2e%20headache%20disorders,lymphocytic%20hypophysitis%3B%20or%20intracranial

%20neoplasm.

Fischer, M., & Jan, A. (2019). Medication-overuse Headache. Europe PMC.

https://doi.org/https://europepmc.org/article/NBK/nbk538150

Jafari, E. (2022). Headache attributed to cranial and/or cervical vascular disorder. Science Direct.

https://doi.org/https://www.sciencedirect.com/science/article/abs/pii/B978032399729400

0120https://www.sciencedirect.com/science/article/abs/pii/B9780323997294000120

Obermann, M., Holle, D., Naegel, S., & Diener, H. C. Headache attributable to nonvascular

intracranial disorders. (n.d.) PubMed.

https://doi.org/https://pubmed.ncbi.nlm.nih.gov/21455738/#:~:text=Some%20of%20thes

Ravishankar, K. (2018). Classification of Trigeminal Autonomic Cephalalgia: What has Changed

in International Classification of Headache Disorders-3 Beta. National Library of

Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909134/

Yeh, W., Blizzard, L., & Taylor, B. (2018). What is the actual prevalence of migraine? Brain and

Behvaiour. https://doi.org/https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.950