HEADACHE
INTRODUCTION
INTRODUCTION
It is most common type of pain.All the tissue of brain are not sensitive to pain.Venous sinuses, dura, cranial blood vessels, olfactory nerve, optic nerve , oculomotar nerve, trigeminal nerve, facial nerve, glossopharyngeal nerve, vagus nerve.
CLASSIFICATION
Tension
type/ muscle contraction/ psychogenic/rheumatic headache: bilateral, constant, squeezing tightness
Migraine headache: Unilateral or Anterior, Throbbing, synchronous with pulse, continuous for Hrs or days with other nervous symptoms.
Cluster headache: unilateral, radiating up or down from one eye, bone- crushing, months to year b/w attacks, in cluster form, nocturnal.
ETIOLOGY
IdiopathicSustained and painful contraction of muscles of scalp & neck.Inflammation of blood vessels & vasodilatation.Trigeminal nerve stimulation due to high neurotransmitter level.Secondary to disorder- stroke, tumor, ENT disease etc.
CLINICAL FEATURE
Pressure or tightness,Nausea & vomitingPhotophobia or phonophobia Visual field defect, tingling & burning sensation, paresthesias,
Weaknessdizziness, confusion, altered consciousness.Hibernate
CLINICAL FEATURE
Conjunctivitis,
Lacrimation, nasal congestion, ptosis, miosis, rhinorrhoea, forehead
and facial swellingSweating
The differential diagnosis is done based on
international headache society (IHS)
DIAGNOSIS
History and physical examinationNeurological examination for infection etc.Routine lab test: CBC, Electrolytes, UrinalysisCT scan of sinusesSpecial studies (CT scan, EEG, MRI, Angiography, EMG)
MANAGEMENT
Collaborative therapies like drugs, meditation, yoga, biofeedback, relaxation tech. are used.
Biofeedback
involves physiological monitoring of equipment regarding muscle tension &
blood flow.
Acupuncture,
Acupressure and hypnosis are also used.
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT
Nonnarcotic analgesic: Aspirin, PCT, ibuprofen, with or without combination of sedatives, muscle relaxant, codeine, tranquilizer.
Serotonin receptor agonist: TRIPTANS like amlotriptan, eletriptan, sumatriptan.
Alpha- Adrenergic blocker : ergotamine (1-2mg oral, sublingually., parenterally or rectal)
Beta blockers: Propanolol
Anti depressant : Amitriptyline, imipramine.
Calcium channel blockers : verapamil
Antiseizures : Sod. valproates
NURSING MANAGEMENT
Assess the patient, obtain history – present, past, medication surgical, personal, diet history .
Perform
physical examination very carefully & completely.
Assess the
type of pain, onset, frequency, duration, relation to events, time of day of
occurrence.
NURSING MANAGEMENT
Nursing
diagnosis :
1. Acute pain RT headache as manifested by complaints of steady, throbbing, or severe crushing pain.
> Assess the patient
> Encourage for patience and alternative therapies
> Provide relaxation therapy
> Provide psychological support
> Administer drugs
> Constant monitoring
NURSING MANAGEMENT
2. Anxiety RT lack of knowledge abt disease
causes, manifestation, treatment
> Assess the level of anxiety.
> Encourage for ventilate feelings.
> Explain abt disease.
> Encourage for treatment.
NURSING MANAGEMENT
Patient
& family teaching
> Maintain dietary calendar
> Avoid amines (cheese, chocolate), nitrate (meat), vinegar, onion,fermented food,
caffeine, ice cream, alcohol,
> Explain abt medication & self administration
> Teach relaxation techniques
> Alternative therapies
> Avoid stress.
