1. HEADACHE
Ms Tarika Sharma
Assistant Professor
MMCON, MMU, Ambala

2. Headache
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.

4. SECONDARY HEADACHE
Symptom associated with an organic cause,
such as brain tumor or an aneurysm.

5. The International Classification of Headache
Disorders (Part I)

6. The International Classification of Headache
Disorders (Part II)

7. The International Classification of Headache
Disorders (Part III)

8. Primary Headaches

9. Secondary Headaches

10. Painful cranial neuropathies, other facial
pains and other headaches

11. CAUSES OF HEADACHE
Brain abscess
Brain tumor
Encephalitis
Hypertension
Meningitis
Intracerebral haemorrhage
Sinusitits
Subarachnoid hemorrhage
Postconcussional syndrome

13. Migraine
Migraine is derived from the word ‘hemicrania’ or ‘half-
a-head’
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

14. Migraine
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
generalised

15. MIGRAINE (Factors associated with an
attack)
Menstrual pattern
Stress (often as crisis is resolving)
Fasting or missing a meal
Certain foods containing tyramine, monosodium
glutamate, nitrites or milk products.eg chocolate,
alcohol, cheese
Extreme changes in weather
Use of OCPs

16. Migraine ( types)
Without aura (headache, nausea, vomiting,
photophobia, phonophobia)
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
pain.
(Related to the cranial blood vessels, the innervation of the
vessels, and the reflex connections in the brain stem.)

18. CLINICAL MANIFESTATIONS (MIGRAINE
WITH AURA)
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

19. Migraine (Management)
AVOIDING TRIGGERS
Dietary : caffeine, chocolate, cheese, nuts,
yoghurt
Stress, smoking, inadequate sleep , hunger

20. MEDICAL MANAGEMENT ( MIGRAINE)
ABORTIVE ( SYMPTOMATIC) APPROACH
PREVENTIVE APPROACH
1. TRIPTANS , serotonin receptor agonists cause
vasoconstriction, reduce inflammation, reduce pain
transmission.
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
and metoprolol.
Amitriptyline hydrochloride, Valproate, and
several serotonin antagonist pizotifen,
methysergide.
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.
Symptoms:
Band like squeezing , tight or pressure sensation
Distributed diffusely or concentrated in temples and occipital region
May be associated with depression, anxiety or stress

23. TENSION HEADACHE

24. PATHOPHYSIOLOGY ( TENSION HEADACHE)
Emotional or physical stress
contraction of muscles in neck and scalp
TENSION HEADACHE

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
Relaxation Therapy
Amitryptyline : 10-50 mg/dl ( Anti
Depressant) irrespective of depression

27. Cluster headache
Usual tendency to occur repetitively over a few
weeks
More common in men
Pain is severe, located in orbit, local redness
swelling
Dilation of orbital and nearby extracranial
arteries

28. CLINICAL MANIFESTATIONS
CLUSTER HEADACHE
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

29. CLUSTER HEADACHE
Management
1. 100% Oxygen by face mask for 15 minutes
2. Ergotamine tartarate, sumatriptan,
corticosteroids.

30. Characteristics
Tension type headache
Chronic and less severe
Most common type
• Cluster headaches
Severe form of vascular headache.
5 Times more frequently in men than in women.

31. Temporal arteritis
A condition in which the temporal arteries,
which supply blood to the head and brain,
become inflamed or damaged.
It is also known as cranial arteritis or
giant cell arteritis.

32. Temporal arteritis…
This condition leads to a throbbing
headache that’s usually in the temples

33. CRANIAL ARTERITIS
Cause of headache in older population ( >
70 yrs)
Inflammation of the cranial arteries is
characterized by a severe headache
localized in the region of the temporal
arteries.
Inflammation may be generalized or focal.

34. Causes
May be linked to the body’s autoimmune
response.
Excessive doses of antibiotics and certain
severe infections have been linked to
temporal arteritis.

35. Pathophysiology ( cranial arteritis)
Immune vasculitis
immune complexes deposited in blood
vessels walls
Vascular injury and inflammation
Cranial arteritis

36. CLINICAL MANIFESTATIONS
CRANIAL ARTERITIS
General manifestations – fatigue, wt loss, malaise and
fever.
Inflammation over the involved artery
sometimes tender, swollen or nodular temporal artery
is visible
Pain on chewing
Headache localized (temporal headache)
visual problems due to ischemia of involved structures

37. MEDICAL MANAGEMENT
CRANIAL ARTERTIS
1. Corticosteroids
2. Analgesics

38. ASSESSMENT AND DIAGNOSTIC
EVALUATION
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
facial muscles.
Laboratory tests: CBC, ESR, glucose, creatinine, Thyroid
hormone levels

39. NURSING MANAGEMENT
GOALS :
To enhance pain relief
To treat acute event of headache
To prevent recurrent episodes

40. NURSING MANAGEMENT
RELIEVING PAIN
1. Individualized treatment depending upon type. During attack ---
Provide comfort; quiet dark environment; head of the bed elevated to
30 degrees; Symptomatic treatment (antiemetics)
2. Analgesics
3. Antidepressants
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
triggers.
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-
up appointments.

43. Thank you!