Headache

 

INTRODUCTION

 

Headache is one of the most common of all human physical complaints. Headache is actually a symptom rather than a disease entity and may indicate organic disease, a stress response, vasodilation, skeletal muscle tension, or a combination of these factors.

A primary headache is one for which no organic cause can be identified. These types of headache include migraine, tension-type, and cluster headaches.

A secondary headache is a symptom associated with organic cause, such as a brain tumor or aneurysm, subarachnoid hemorrhage, stroke, hypertension, meningitis, and head injury.

(Brunner & Suddarth’s 2010)

 

DEFINITION

Headache is probably the most common type of pain experienced by humans. Headache is a common symptom of many neurologic conditions and is also a separate disease process.

(Basavanthappa 2009)

 

 

ETIOLOGY              

1.      Sinus headache

2.      Tension-type headache                                   

3.      Migraine headache

4.     Cluster headache

 

1)    SINUS HEADACHE

Sinus headache are headaches that may feel like an infection in the sinuses (sinusitis). You may feel pressure around the eyes, cheeks and forehead. Perhaps your head throbs. But, this pain might actually be caused by a migraine.

 

2)    TENSION-TYPE HEADACHE

 Occurs at any age and is associated with stress. Onset often in adolescence, related to tension or anxiety. There will be no family history. It is episodic, vary with stress; duration is variable. The pain is usually bilateral, occurring most often in the back of the neck. It usually does not interfere with sleep. The headache occurs intermittently for weeks, months or even years.

 

3)    MIGRAINE HEADACHE

 Migraine occurs more often in women than men most commonly begins between adolescence and at the 40 years. They demonstrate a strong hereditary pattern, but no specific genetic link has been identified. It is episodic, tends to occur with stress or life crisis it lasts. Lasts hours to days. It occurs slowly. Pain becomes severe with one side of head affected more than other.

 

4)    CLUSTER HEADACHE 

Cluster headache is one of the most severe forms of head pain. No epidemiological pattern has been identified occurs in early adulthood, precipitated by alcohol or nitrate use, more common in older men. Episodes clustered together in quick succession for few days or weeks with remissions that lasts for months. It lasts a minute to a few hours.

CLINICAL MENIFESTATIONS

·        SINUS HEADACHE

o   Bad breath

o   Decreased or absent sense of smell

o   Fever

o   Nasal congestion

o   Stuffy nose

o   Nasal discharge

o   Runny nose

o   Nasal membrane swelling

·        TENSION-TYPE HEADACHE

o   Dull head pain

o   Pressure around the forehead

o   Tenderness around the forehead and scalp

 

·        MIGARINE HEADACHE

o   Aura (sensitivity to light and sound)

o   Vision field defects

o   Confusion

o   Paresthesia

o   Nausea

o   Vomiting

o   Chills

o   Fatigue

o   Irritability

o   Sweating

o   Edema

·        CLUSTER HEADACHE

o   Flushing

o   Tearing of eyes

o   Nasal stuffiness

o    

 

PATHOPHYSIOLOGY

The pathophysiology of headache is not fully understood. Some structures of the head are incapable of sensing pain. The structures that are capable of feeling pain are skin, muscles, periosteum of the skull, eyes, ears, nasal cavities and sinuses, meninges, cerebral blood vessels, and cranial nerves with sensory function. Pain is caused by vasodilation of blood vessels. Serotonin is the primary neurotransmitter found in the pathways involved in the headache, but its role is not fully understood.

 

`                                   When cerebral blood vessels narrow

                           

 

Blood flow is reduced to some areas of the brain

                         

 

Initial vasoconstriction is followed by significant vasodilation

                           

 

Inflammation of the blood vessels

                           

 

This triggers a release of serotonin

                      

 

Cause headache

 

TREATMENT

Medications for the treatment of headache fall into two broad categories: symptom relief and prevention.

Ø SYMPTOMATIC TREATMENT

Following drugs are used:

a)      Non-narcotic analgesics (aspirin, acetaminophen and ibuprofen).

b)      Analgesics combinations (butalbital).

c)      Muscle relaxants.

d)      Serotonin receptor agonists (sumatriptan, naratriptan, rizatriptan).

e)      Alpha-adrenergic blockers (ergatramine tartrate).

f)       Vasoconstrictors (isometheptone).

g)      Corticosteroids (dexamethasone).

h)    Metodopramide.

 

Ø PROPHYLACTIC TREATMENT

Includes the following:

a)      Tricyclic antidepressants (doxepin, amitriptyline).

b)      Beta-adrenergic blockers (propranolol, Inderal).

c)      Biofeedback.

d)      Muscle relaxation training.

e)      Psychotherapy.

f)       Calcium channel blockers (isoptin).

g)      Divalp

h)      Yoga, meditation, electric counter stimulation.

i)       Corticosteroids (prednisone).

j)       Lithium.

k)      Alpha-adrenaline blockers (used in cluster headache).

l)       Serotonin antagonists.

NURSING CARE PLAN

ASSESSMENT	NURSING DIAGNOSIS	PLANNING	NURSING INTERVENTIONS	EVALUATION
Subjective Data Patient verbalize that She/he is suffering from severe pain on right side of the head since 2 to 3 days.       Objective Data ·         Blood pressure 130/80mmhg ·         Pulse 88/min ·         Temp 99F ·         Pain scale 7/10 ·        Facial expression.	Acute pain Related to stress As evidence by severity of pain (7/10) Secondary to disease process.	Short term planning 2hour’s Relieve pain Calm & quite  environment Relieve nausea and vomiting Reduce stress     Long term planning Counseling to coping stress or depression.	Independent ·         Provide bed ·         Comfortable positioning ·         Attach oxygen if required ·         Secure i/v line ·         Give over the counter drug (paracetamol) ·         Call to doctor ·         Noise free surroundings ·         Encourage adequate rest periods. ·         Increased intake of drink like plenty of water. Dependent ·         Give analgesics as advised by doctor like aspirin ·         Give muscle relaxants as prescribed ·         Antiemetic drugs as order by doctor ·         Give antidepressants as advised Collaborative ·         Send call to psychology for psychotherapy ·         Call to physiotherapy for Muscle relaxation training ·         Advise yoga , meditation for relaxation ·        Counseled the attendants to avoid stressful environment.	Short term goal After 2hour’s nursing interventions patient verbalized that his/her pain settled down and he/she is feeling better.             Long term goal After 2weeks follow up patient is feeling better and stress free.

NURSING CARE PLAN

ASSESSMENT	NURSING DIAGNOSIS	PLANNING	INTERVENTION	EVALUATION
Subjective data Patient verbalize that She/he is suffering from severe pain on whole head since 3 to 4 days.     Objective Data ·         Blood pressure 110/80mmhg ·         Pulse 80/min ·         Temp 98F ·         Pain scale 6/10	Disturbed sleep pattern Related To anxiety As Evidence By irritability Secondary To Disease process.	Short term planning 2hour’s Relieve pain Calm environment Relieve nausea and vomiting Reduce stress.   Long term planning Counseling to coping stress or depression.	Independent ·         Provide bed ·         Comfortable positioning ·         Attach oxygen if required ·         Monitor vital signs ·         Secure i/v line ·         Give over the counter drug (paracetamol) ·         Call to doctor ·         Keep calm and dim light environment ·         Noise free ·         Advice a regular sleep schedule ·         Advise to improve physical activity in daily routine. ·         Encourage for oral intake of water. Dependent ·         Give analgesics as advised by doctor like aspirin ·         Give muscle relaxants as prescribed ·         Antiemetic drugs as order by doctor ·         Give antidepressants as advised Collaborative ·         Send call to psychology for psychotherapy ·         Call to physiotherapy for Muscle relaxation training ·         Advise yoga , meditation for relaxation ·         Counseled the attendants to avoid stressful environment.	Short term goal After 2hour’s nursing interventions patient verbalized that his/her pain settled down and he/she is feeling better.       Long term goal After 2weeks follow up patient is feeling better and stress free.

 

 

NURSING CARE PLAN

ASSESSMENT	NURSING DIAGNOSIS	PLANNING	INTERVENTION	EVALUATION
Subjective data Patient verbalize that She/he is suffering from severe pain on whole head since 3 to 4 days.     Objective Data ·         Blood pressure 130/80mmhg ·         Pulse 88/min ·         Temp 99F ·         Pain scale 7/10 facial. ·        Restlessness.	Impaired comfort Related To headache As Evidence By irritability Secondary To Disease process.	Short term planning 2hour’s Relieve pain. Provide Calm environment. Dim light but good ventilation. Relieve anxiety. Reduce stress.   Long term planning Counseling to coping stress or depression.	Independent ·         Provide bed ·         Comfortable positioning ·         Attach oxygen if required ·         Secure i/v line ·         Give over the counter drug (paracetamol) ·         Call to doctor ·         Keep calm and dim light environment ·         Encourage adequate rest periods. ·         Counseled to avoid too much use of cellphone and television. ·         Increased intake of drink like plenty of water. Dependent ·         Give analgesics as advised by doctor like aspirin ·         Antiemetic drugs as order by doctor ·         Give antidepressants as advised Collaborative ·         Send call to psychology for psychotherapy. ·         Call to ophthalmology for vision test. ·         Call to physiotherapy for Muscle relaxation training ·         Advise yoga , meditation for relaxation ·        Counseled the attendants to avoid stressful environment.	Short term goal After 2hour’s nursing interventions patient verbalized that his/her pain settled down and he/she is feeling better.       Long term goal After 2weeks follow up patient is feeling better and stress free.

 

SUMMARY

Headache is probably the most common type of pain in humans. Head is often begins in early morning. The classic migraine attack can be divided into four phases: prodrome, aura, headache and recovery. Presents in 60% of patients with migraine headache. Symptoms may occur consistently hours to days before onset of migraine. Depression, irritability, feeling cold, food cravings, anorexia and so on noted with headache. There is a period of muscle contraction in the neck and scalp with associated muscle ache and localized tenderness, exhaustion and mood changes. The overall goals that patients with headache have reduced or no pain. Experience increased comfort and decreased anxiety. Demonstrate understanding of triggering events and treatment strategies. Use positive coping strategies to deal with chronic pain.

 

REFERENCES

·         Basavanthappa, (2009) medical surgical nursing: Headache (2^nd edition) page#849.

·         Brunner & Suddarth’s,(2011) medical surgical nursing: Headache (12^th edition) page#330.

·         Dr. Inam Danish,(2006) medical diagnosis and management:(8^th edition) page# 650.