Headache Management: Chapter 5

Headache Management: Chapter 5

• Patient Assessment: Assess patient, pain, medical history and prior treatments.

• Self-Treatment Exclusions:

  • Severe head pain
  • Headaches with rapid onset of maximum pain
  • Significant changes in headache pattern
  • Headaches lasting 10+ days, whether treated or not
  • Age < 8 years old
  • High fever/signs of serious infection
  • Neck stiffness (meningitis)
  • Neurological changes (vision disturbances, seizure, altered mental status)
  • High-risk comorbidities (cancer, HIV)
  • Last trimester of pregnancy
  • New headaches during pregnancy
  • Headaches due to underlying medical condition (except for mild sinus headaches)
  • Symptoms consistent with migraine without diagnosis
  • History of liver disease or ≥3 alcoholic drinks daily

• Medical Referral: Referral if exclusions for self-treatment apply, or if headache persists. -Analgesic use >3 days/week? -Yes: Medical referral - No: Consider appropriate nonpharmacologic & pharmacologic therapy or treatment for decreasing analgesic use over several days, then medical referral.

• Drug Avoidance: -<12 years old: Avoid salicylates and avoid naproxen -<18 years old: Avoid salicylates

• Analgesic Use: Use acetaminophen, an NSAID, or salicylate as appropriate if analgesia is adequate.

  • Follow-up recommended after 4-6 weeks, based on frequency/severity of headaches

• Analgesic Reduction (if needed): Decrease analgesic use over time, referral if persisting headache.

• Migraine Assessment Patients diagnosed with Migraine or sinus or tension-type headaches proceed to appropriate therapy recommendations.

Analgesic Types

• Acetaminophen: For pain relief & fever
• NSAIDs: Ibuprofen, naproxen for pain relief (but consider age restrictions & drug interactions).
• Salicylates: Aspirin for pain relief (restrict use in children <18)

General Headaches

• Hyperthermia: Malfunctioning of thermoregulatory process.
• Hyperpyrexia: Body temperature above 106°F.
• Normal Temperature: 97.5-98.9°F
• Pyrogens: Fever-producing substances.
• Prostaglandins: Response to pathogens.

Chronic Headaches

• Tension-Type Headaches: Most common, stress-related.

• Migraines: More severe, trigeminovascular system dysfunction or episodic.

• Sinus Headaches: Associated with sinus symptoms.

• Non-pharmacological Therapy: For Chronic Tension-Type Headaches - Relaxation exercises, strengthening of head and neck muscles, acupuncture.

• Important Considerations: Timing, frequency, and severity of headaches are crucial factors impacting treatment and management strategies.

This quiz focuses on Chapter 5 of headache management, emphasizing patient assessment and self-treatment exclusions. It outlines critical criteria for medical referrals for headaches that may not be suitable for self-treatment. Test your understanding of these guidelines and improve your management strategies.