Headache, Pain & Fever Spring 2025 PDF

Pain, Headache, and Fever Em i li e Hegg en, Phar m D Febr ua r y 1 0, 20 25  OBJECTIVES 1. List common causes/triggers of headache, pain, and fever 2. Differentiate between types of pain and headache 3. Describe non-medication strategies for headache, pain, and fever 4. Di...

Pain, Headache, and Fever Em i li e Hegg en, Phar m D Febr ua r y 1 0, 20 25  OBJECTIVES 1. List common causes/triggers of headache, pain, and fever 2. Differentiate between types of pain and headache 3. Describe non-medication strategies for headache, pain, and fever 4. Discuss appropriate OTC options for headache, pain, and fever 5. Identify situations where self-care is NOT appropriate for managing headache, pain, and fever PAIN DEF IN ITION OF PAIN Unpleasant sensory and emotional experience Associated with actual or potential tissue damage Subjective and complex PA I N PATH WAY Nociception refers to the physiologic response to painful stimuli OTC pain relievers mostly work to inhibit or block the transduction of pain signals T Y P E S & C L A S S I F I C AT I O N S O F PA I N Acute < 4 weeks Subacute 4 weeks up to 3 months Chronic > 3 months Handbook of Nonprescription Drugs. Chapter 7: Musculoskeletal Injuries and Disorders. 20 th ed; 2020. T Y P E S & C L A S S I F I C AT I O N S O F PA I N Nociceptive Neuropathic Tissue damage Nerve damage or inflammation Somatic Visceral Originates from Originates from muscles, bones, internal organs or soft tissues and blood vessels M U S C U L O S K E L E TA L D I S O R D E R S Myalgia Tendonitis Bursitis Sprain Strain Osteoarthritis Handbook of Nonprescription Drugs. Chapter 7: Musculoskeletal Injuries and Disorders. 20 th ed; 2020. EXCLUSIONS FOR SELF-CARE Severe pain > 6 Nausea, vomiting, fever or other signs of infection Pain that lasts > 10 days < 2 years old Pain that continues > 7 days after treatment with a topical analgesic Back pain with loss of bowel and/or bladder control Increased intensity or change in character Arthritis pain that requires use of a topical Pelvic or abdominal pain (not related to NSAID >21 days dysmenorrhea) Arthritis pain that has not improved after 7 days Pregnancy of using a topical NSAID Handbook of Nonprescription Drugs. Chapter 7: Musculoskeletal Injuries and Disorders. 20 th ed; 2020. N O N - D R U G T R E AT M E N T S : PREVENTION Injury from sports or exercise can be prevented “Warming up” stretching Proper hydration Appropriate footwear N O N - D R U G T R E AT M E N T S : RICE V S. MEAT THE RAP Y R = Rest M = massage I = ice E= C = compression A = analgesics E = elevate T= N O N - D R U G T R E AT M E N T S : H EAT May be helpful for muscle stiffness or osteoarthritis Thought to work by increasing blood flow and reducing muscle spasms Apply for 15-20 minutes, 3-4 times per day Examples: heating pad, hot water bottle, warm wet compress, Thermacare patch Handbook of Nonprescription Drugs. Chapter 7: Musculoskeletal Injuries and Disorders. 20th ed; 2020. N O N - D R U G T R E AT M E N T S : T R A N S C U TA N E O U S E L E C T R I C A L S T I M U L AT I O N ( T E N S ) Low-voltage electric currents that stimulate nerve fibers, activating opioid receptors May be an effective adjunct to acute musculoskeletal injuries or low-back pain Lots of variation between devices and their settings Contraindications: presence of pacemaker/defibrillator, broken skin at application site, significant lymphedema Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury. Journal of Orthopaedic Trauma 33(5):p e158-e182, May 2019. N O N - D R U G T R E AT M E N T S : O T H E R POTENTIAL OPTIONS Yoga Tai Chi O T C T R E AT M E N T O P T I O N S Oral Topical Acetaminophen (Tylenol) Diclofenac (Voltaren) Naproxen (Aleve) Lidocaine Ibuprofen (Motrin) Counterirritants (Menthol, camphor, Methyl salicylate) Capsaicin A C E TA M I N O P H E N ( T Y L E N O L ) Analgesic and antipyretic Acetaminophen Usual adult dose 325-1000 mg every 4-6 hours Blocks pain receptors in the brain Max adult dose 3000 mg per day Extensive hepatic metabolism Onset of action 30 minutes Safe in pregnancy and infants Duration of action 4 hours Handbook of Nonprescription Drugs. Chapter 7: Musculoskeletal Injuries and Disorders. 20 th ed; 2020. A C E TA M I N O P H E N TOXICITY W H AT ’ S T H E DIFFERENCE? NSAIDS (IBUPROFEN & NAPROXEN) Ibuprofen Naproxen (Aleve) (Advil/Motrin) Analgesic and antipyretic Usual adult 200-400 mg every 440 mg initially, then 220 dose 6-8 hrs mg every 8-12 hours Renal elimination Max adult 1200 mg 660 mg dose Ulcers.. Onset of 30 minutes 30 minutes action Avoid in cardiovascular disease and Duration of 6-8 hours 12 hours hypertension action Available as Tablets, capsules, Tablets, capsules Aspirin … liquid, chewable tab D I C L O F E N A C ( V O LTA R E N ) Topical NSAID Best for arthritis pain relief on elbow, wrist, hand, foot or ankle Apply 2 grams (upper body) or 4 grams (lower body) 4 times per day Do not apply to more than 2 body areas at the same time LIDOCAINE Local anesthetic = Numbing action May be used for mild neuropathic or muscle pain Max use of 7 days without medical follow-up Apply topically every 6-8 hours; max 3 times per day May cause allergic skin reactions C O U N T E R I R R I TA N T S Menthol, camphor, methyl salicylate Cooling sensation detracts from pain Apply 3–4 times per day, as needed, for up to 7 days May cause skin burns at higher concentrations Camphor may be toxic in children if swallowed CAPSAICIN (CAPZASIN) Derived from chili peppers Causes burning or “heat” sensation May be used for arthritis pain or nerve pain Apply 3–4 times per day, as needed, for up to 7 days Consider wearing gloves to apply to avoid contact with eyes and other sensitive areas May cause skin burning, cough, or runny nose T R O L A M I N E S A L I C Y L AT E May have an anti-inflammatory effect Related to aspirin Limited studies or research on this drug Less scent or local irritation than counterirritants Apply 3–4 times per day, as needed, for up to 7 days TOPICAL PAIN RELIEVERS SU MMARY Do not apply to irritated, wounded or open skin Stop use if pain, swelling, or blistering occurs Less side effects Do not tightly bandage areas where topical pain Apply directly to the site of pain relievers are applied Do not apply heat to areas where topical pain Irritation or allergic reaction relievers are applied Messy Avoid contact with eyes, inside nose or mouth, Smell or with genitals CASE #1 HEAD AC HE TYPES OF HEADACHES Tension Sinus Migraine Medication Overuse TYPES OF HEADACHES Tension Headache Sinus Headache Migraine Headache Location Both sides of head Face, forehead, eye sockets One side of head (usually) Diffuse ache, tightening, Pressure behind eyes or Characteristics Throbbing, pulsating pressing, constricting sinuses, dull pain Intensity Mild-moderate Mild-severe Moderate-severe At same time as sinus Onset Gradual Sudden symptoms Days (resolves with sinus Duration 30 minutes to 7 days 4-72 hours symptoms)  Tension Headache Most common type of headache Triggers: eye strain, stress, anxiety, insomnia Occurs more commonly in women than men – 3:2 ratio Can be episodic or chronic – Chronic = more than 15 days per month over 3+ months Handbook of Nonprescription Drugs. Chapter 5: Headache. 20 th ed; 2020.  Sinus Headache Cause: infection or blockage of sinus cavities, swelling of nasal/sinus passages Common in individuals with allergies Treatment may include decongestants in addition to pain relievers – Pseudoephedrine (oral), phenylephrine, (oral or nasal), oxymetazoline (nasal) Sinus rinses (i.e. Netipot) may be beneficial in treatment or preventing future occurrences  Migraine Headache 2nd leading cause of disability globally – ~1/3 of individuals worldwide suffer from migraines Twice as likely in females compared to males May start with or without aura Individuals may have prodrome symptoms – Physiologic changes that can occur 1-2 days before migraine attack  Migraine Headache Prodrome: hours to days before Aura: 5-60 minutes before Irritability Depression Visual: Yawning shimmering or flashing light, seeing stars, zigzags, or spots, blind spots Fatigue Difficulty sleeping Sensory: Food cravings numbness or tingling in face, hands, or fingers, typically on one side Problems concentrating Constipation or diarrhea Motor: speech problems or muscle weakness Handbook of Nonprescription Drugs. Chapter 5: Headache. 20 th ed; 2020. American Migraine Foundation. The Timeline of a Migraine Attack. [Online]  Includes at least 2 of the following: Migraine Headache Moderate to severe head pain Pain on one side of head Pulsating pain Aggravated by physical activity May also include: Nausea or vomiting Sensitivity to light or sounds Dizziness or light-headedness Ringing in ears Blurred vision Sinus symptoms Image: https://www.painfreenyc.com/best-headache-clinic-brooklyn-migraine- specialist/ Handbook of Nonprescription Drugs. Chapter 5: Headache. 20 th ed; 2020. CAFFEINE Consuming 200-400 mg of caffeine per day is considered generally safe for healthy, non-pregnant adults Increases absorption of pain relievers The Narrows blood vessels in the brain Good Interferes with pain signaling Regular use leads to dependence The Stopping abruptly leads to enlargement of blood vessels in the brain Bad High doses can evoke anxiety, tremors, insomnia, etc. Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature. Nutrients. 2023 Jul 17;15(14):3170. Medication Overuse Headaches Headache 15 or more days of Prevention: the month due to taking pain Avoid medication (both non-prescription and relief medications frequently (more than twice per week) prescription) for headaches more than twice per week for more than 3 months Treatment: Stop offending agent Caffeine use of more than Headache may get worse before it gets better 200 mg per day can increase May need to seek medical provider for a prescription risk of medication overuse headaches preventative headache treatment Caution: Combination Products FEVER W HAT IS A FE VE R ? A temporary increase in body temperature Signifies that something abnormal is going on with your body, but usually is not a cause for major concern Believed to play a role in assisting your body in fighting off infections Most common cause of fever is infection (virus, bacteria) Average “normal” body temperature = 98.6 F Fever: body temperature ≥ 100.4 F S YMP TOM S A SS O C IATE D W ITH FE VE R Muscle Sweating Chills Headache aches Loss of General Irritability Dehydration appetite weakness TYPES OF THERMOMETERS Temporal Tympanic (ear): Rectal: Oral: Axillary (armpit): (forehead): Normal temp = Normal temp = Normal temp = Normal temp = Normal temp = 97.9 - 100.1 F 96.3 - 100 F 97.9 - 100.4 F 95.9 - 99.9 F 94.5 - 99.3 F THERMOMETERS Rectal thermometer: Tympanic thermometer: “Gold standard” – closest reading to core body temperature Accurate reading of core body temperature Preferred route of measurement in infants Must be positioned in ear canal properly Use lubricant, such as petroleum jelly, for ease of Use infrared technology = quick readout; < 5 application seconds Oral thermometer: Do not use in under age 3 Temporal or forehead thermometers Clean between patient uses or use disposable cover Quick readout Do not eat or drink 30 minutes before use Noninvasive Axillary thermometer Hair or sweat may interfere with reading Less invasive Not as reliable as oral or rectal readings N ON - M ED I CATI ON TR EATM EN T OF FE VE R – Rest Physical activity can raise body temp – Stay cool Dress in light clothing, sleep with only a sheet – Hydration Drink plenty of fluids, water is preferred O T C T R E AT M E N T S T R E AT M E N T O F C H I L D R E N & I N FA N T S **want to talk about differences between Tylenol, when to refer, etc. EXCLUSIONS FOR SELF-CARE Adults and children: Children Temp > 104° F Vomiting, diarrhea Severe headache Refuses to drink fluids Fever that lasts longer than 3 days Not urinating or no/few wet diapers Severe signs of infection Very sleepy, difficult to wake, or irritable Impaired immune function Stiff neck Develops a rash History of febrile seizures < 2 years old and fever > 24 hours < 3 months old and fever >100.4° F