Headache or cephalgia is one of the most common of
all human complaints.
Symptom rather than disease entity.
May indicate organic disease, a stress response,
vasodilatation (migraine), skeletal muscle tension (
tension headache), or a combination of factors.
3. Primary headache
Primary headache is one for which no
organic cause can be identified.
These types of headache include: migraine,
tension- type, and cluster headaches.
Migraine is derived from the word ‘hemicrania’ or ‘half-
Migraine is a symptom complex characterized by
periodic and recurrent attacks of severe headache
lasting from 4 -72 hours in adults.
Primarily a vascular disturbance that occurs more
commonly in women and has a high familial tendency.
Incidence highest in adults 20- 35 yrs of age.
Typical time of onset: puberty
Episodic, lasting 4-72 h, associated with nausea and/or
vomiting, photophobia (increased sensitivity to light) and
phonophobia (increased sensitivity to sound )and interferes
with day-to-day functioning.
Headache has a throbbing or pulsatile quality and is often
unilateral (2/3rds of patients) although may become
15. MIGRAINE (Factors associated with an
Stress (often as crisis is resolving)
Fasting or missing a meal
Certain foods containing tyramine, monosodium
glutamate, nitrites or milk products.eg chocolate,
Extreme changes in weather
Use of OCPs
16. Migraine ( types)
Without aura (headache, nausea, vomiting,
With aura ( visual: flashing lights; speech
difficulty; sensory disturbances with paresis
of arms or legs; motor changes with
weakness + additional symptoms)
17. Pathophysiology ( migraine)
Abnormal metabolism of serotonin.
Rise in plasma serotonin, which dilates the cerebral vessels.
Dysfunction of the brain stem pathways that normally modulate
sensory input .
Cerebral signs and symptoms of migraine, Pulsating , throbbing
(Related to the cranial blood vessels, the innervation of the
vessels, and the reflex connections in the brain stem.)
18. CLINICAL MANIFESTATIONS (MIGRAINE
Migraine with aura …4 phases.
1. PRODROME (Occurs hours to days before a migraine headache;
depression, food cravings, feeling cold, anorexia, increased urination,
diarrhea or constipation )
2. AURA PHASE ( Lasts less than 1 hour; focal neurologic symptoms.
Visual disturbances ( light flashes and bright spots) are common and
may be hemianopic .
3. HEADACHE PHASE ( Throbbing headache ---unilateral in 60%,
intensifies over several hours; often associated with photophobia, nausea
and vomiting; 4-72 hours)
4. RECOVERY PHASE (TERMINATION AND POSTDROME)
Pain gradually subsides; muscle contraction in neck and scalp is
common, exhaustion , mood changes. May sleep for long hrs
20. MEDICAL MANAGEMENT ( MIGRAINE)
ABORTIVE ( SYMPTOMATIC) APPROACH
1. TRIPTANS , serotonin receptor agonists cause
vasoconstriction, reduce inflammation, reduce pain
SUMATRIPTAN, NARATRIPTAN, RIZATRIPTAN, ALMOTRIPTAN.
2. ERGOTAMINES..acts on smooth muscle…prolonged
constriction of cranial blood vessels.
3. Newer AEDs – gabapentin and topiramate under research
21. Preventive Drug therapy ( Migraine)
Beta-blocking agents, propranolol
Amitriptyline hydrochloride, Valproate, and
several serotonin antagonist pizotifen,
Calcium antagonists (verapamil HCl)
22. Tension Headache
Tight bands around head
Very common and hard to relieve
Affects 3% of population
More prevalent in women than men ( 1.5: 1)
Commonest age at onset: second decade
Causes are sources of state of tension.
Band like squeezing , tight or pressure sensation
Distributed diffusely or concentrated in temples and occipital region
May be associated with depression, anxiety or stress
25. TENSION TYPE HEADACHE
Steady, constant feeling of pressure ; usually
begins in forehead, temple or back of neck.
Band like ……..a weight on top of my head
26. Treatment ( tension headache)
Analgesics Not Very Helpful
Amitryptyline : 10-50 mg/dl ( Anti
Depressant) irrespective of depression
27. Cluster headache
Usual tendency to occur repetitively over a few
More common in men
Pain is severe, located in orbit, local redness
Dilation of orbital and nearby extracranial
28. CLINICAL MANIFESTATIONS
Unilateral and come in clusters of 1-8 daily;
excruciating pain localized to eye and orbit and
radiating to facial and temporal regions.
Watering of eyes and nasal congestion
15 min – 3 hrs
crescendo- decrescendo pattern
33. CRANIAL ARTERITIS
Cause of headache in older population ( >
Inflammation of the cranial arteries is
characterized by a severe headache
localized in the region of the temporal
Inflammation may be generalized or focal.
May be linked to the body’s autoimmune
Excessive doses of antibiotics and certain
severe infections have been linked to
35. Pathophysiology ( cranial arteritis)
immune complexes deposited in blood
Vascular injury and inflammation
36. CLINICAL MANIFESTATIONS
General manifestations – fatigue, wt loss, malaise and
Inflammation over the involved artery
sometimes tender, swollen or nodular temporal artery
Pain on chewing
Headache localized (temporal headache)
visual problems due to ischemia of involved structures
38. ASSESSMENT AND DIAGNOSTIC
Detailed history ( med surg illness, medication history, family
history , stress, occupational history-toxic substances, complete
description of headache)
Physical assessment of head and neck
Complete neurologic examination
CT, cerebral angiography, MRI : to detect underlying cause
Electromyography ; sustained contraction of neck , scalp or
Laboratory tests: CBC, ESR, glucose, creatinine, Thyroid
40. NURSING MANAGEMENT
1. Individualized treatment depending upon type. During attack ---
Provide comfort; quiet dark environment; head of the bed elevated to
30 degrees; Symptomatic treatment (antiemetics)
4. Muscle relaxants
5. Local heat or massage
6. Diversion therapies
41. Teaching Patients Self-Care
Education about the type of headache, its mechanism
(if known), and appropriate changes in lifestyle to avoid
Regular sleep, meals, exercise, and avoidance of dietary
triggers may be helpful in avoiding headaches.
The patient with tension headaches needs teaching and
reassurance that the headache is not due to a brain tumor.
This is a common unspoken fear.
42. Teaching Patients Self-Care…
Stress reduction techniques, such as biofeedback,
exercise programs, and meditation, are examples of
nonpharmacologic therapies that may prove helpful.
Patients and their families need to be reminded of
the importance of following the prescribed
treatment regimen for headache and keeping follow-