Headache PDF

10/24/23, 3:21 PM Realizeit for Student Headache Headache, or cephalalgia, is one of the most common of all human physical complaints. Headache is a symptom rather than a disease entity; it may indicate organic disease (neurologic or other disease), a stress response, vasodilation (migraine), skel...

10/24/23, 3:21 PM Realizeit for Student Headache Headache, or cephalalgia, is one of the most common of all human physical complaints. Headache is a symptom rather than a disease entity; it may indicate organic disease (neurologic or other disease), a stress response, vasodilation (migraine), skeletal muscle tension (tension headache), or a combination of factors. A primary headache is one for which no organic cause can be identified. This type of headache includes migraine, tension-type, and cluster headaches (Hickey & Strayer, 2020). Cranial arteritis is another common cause of headache. A classification of headaches was issued first by the Headache Classification Committee of the International Headache Society (IHS) in 1988. The IHS revised the headache classification in 2018; an abbreviated list is shown in Chart 61-7. Migraine is a complex of symptoms characterized by periodic and recurrent attacks of severe headache lasting from hours to days in adults. The cause of migraine has not been clearly demonstrated, but it is primarily a vascular disturbance that has a strong familial tendency. The typical time of onset is at puberty, and the incidence is higher in women than men (Hickey & Strayer, 2020). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 1/4 10/24/23, 3:21 PM Realizeit for Student There are many subtypes of migraine headache, including migraine with and without aura. Most patients have migraine without an aura. Tension-type headaches tend to be chronic and less severe and are probably the most common type of headache. Trigeminal autonomic cephalalgias include cluster headaches and paroxysmal hemicrania. Cluster headaches are relatively uncommon and seen more frequently in men than in women (Norris, 2019). Types of headaches not subsumed under these categories fall into the other primary headache group and include headaches triggered by cough, exertion, and sexual activity (IHS, 2018). Cranial arteritis is a cause of headache in the older population, reaching its greatest incidence in those older than 70 years of age. Inflammation of the cranial arteries is characterized by a severe headache localized in the region of the temporal arteries. The inflammation may be generalized (in which case cranial arteritis is part of a vascular disease) or focal (in which case only the cranial arteries are involved). A secondary headache is a symptom associated with other causes, such as a brain tumor, an aneurysm, or lumbar puncture. Although most headaches do not indicate serious disease, persistent headaches require further investigation. Serious disorders related to headache include brain tumors, subarachnoid hemorrhage, stroke, severe hypertension, meningitis, and head injuries. Pathophysiology The cerebral signs and symptoms of migraine result from a hyperexcitable brain that is susceptible to a phenomenon known as cortical spreading depression, a wave of depolarization over the cerebral cortex, cerebellum, and hippocampus. This depolarization activates inflammatory neuropeptides and other neurotransmitters (including serotonin), resulting in the stimulation of meningeal nociceptors. Vascular changes, inflammation, and a continuation of pain signal stimulation occur (Goadsby & Holland, 2019). The initial phase of this process is known as the premonitory phase and may include light, sound, and smell sensitivity. If treatment is initiated at this point, the migraine may be fully terminated. As the attack progresses, central sensitization occurs, and the migraine becomes much harder to treat. Attacks can be triggered by hormonal changes associated with menstrual cycles, bright lights, stress, depression, sleep deprivation, fatigue, or odors. Certain foods containing tyramine (aged cheese, red wine, beer), monosodium glutamate, and chocolate may be food triggers (Hickey & Strayer, 2020). The use of oral contraceptives may be associated with increased frequency and severity of attacks in some women. Emotional or physical stress may cause contraction of the muscles in the neck and scalp, resulting in tension headache. The pathophysiology of cluster headache is not fully understood. One theory is that it is caused by dilation of orbital and nearby extracranial arteries. Cranial arteritis is thought to https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 2/4 10/24/23, 3:21 PM Realizeit for Student represent an immune vasculitis in which immune complexes are deposited within the walls of affected blood vessels, producing vascular injury and inflammation. A biopsy may be performed on the involved artery to make the diagnosis. Clinical Manifestations Migraine The migraine with aura can be divided into four phases: premonitory, aura, the headache, and recovery (headache termination and postdrome). Premonitory Phase The premonitory phase is experienced by more than 80% of adult migraine sufferers, with symptoms that occur hours to days before a migraine headache. Symptoms may include depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination, diarrhea, or constipation. Patients may experience the same prodrome with each migraine headache. A current theory regarding premonitory symptoms is that they involve the neurotransmitter dopamine. Aura Phase An aura may be a variable feature for patients who experience migraines and can be seen in about 30% of patients (Goadsby & Holland, 2019). An aura is characterized by focal neurologic symptoms. Visual disturbances (i.e., light flashes and bright spots) are most common and may be hemianopic (affecting only half of the visual field). Other symptoms that may follow include numbness and tingling of the lips, face, or hands; mild confusion; slight weakness of an extremity; drowsiness; and dizziness. This period of aura was thought to correspond to the phenomenon of cortical spreading depression that is associated with reduced metabolic demand in abnormally functioning neurons. This can be associated with decreased blood flow; however, cerebral blood flow studies performed during migraine headaches demonstrate that although changes in blood vessels occur during phases of migraine, cerebral blood flow is not the main abnormality. In fact, some studies suggest that the aura and headache phases may occur simultaneously (Goadsby & Holland, 2019). Headache Phase Migraine headache is severe and incapacitating and is often associated with photophobia (light sensitivity), phonophobia (sound sensitivity), or allodynia (abnormal perception of innocuous stimuli) (Goadsby & Holland, 2019). Research differs in the role of vascular changes (either vasodilatory or vasoconstrictive) with respect to migraine pathophysiology and the experience of migraine headache. Symptoms of migraine can also include nausea and vomiting. Postdrome Phase In the postdrome phase, the pain gradually subsides, but patients may experience tiredness, weakness, cognitive difficulties, and mood changes for hours to days. Muscle contraction in the neck https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 3/4 10/24/23, 3:21 PM Realizeit for Student and scalp is common, with associated muscle ache and localized tenderness. Physical exertion may exacerbate the headache pain. During this postheadache phase, patients may sleep for extended periods. Other Headache Types The tension-type headache is characterized by a steady, constant feeling of pressure that usually begins in the forehead, temple, or back of the neck. It is often bandlike or may be described as “a weight on top of my head.” Cluster headaches are unilateral and come in clusters of one to eight daily, with excruciating pain localized to the eye and orbit and radiating to the facial and temporal regions. The pain is accompanied by watering of the eye and nasal congestion. Each attack lasts 15 minutes to 3 hours and may have a crescendo–decrescendo pattern (Hickey & Strayer, 2020). The headache is often described as penetrating. Cranial arteritis often begins with general manifestations, such as fatigue, malaise, weight loss, and fever. Clinical manifestations associated with inflammation (heat, redness, swelling, tenderness, or pain over the involved artery) usually are present. Sometimes a tender, swollen, or nodular temporal artery is visible. Visual problems are caused by ischemia of the involved structures. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 4/4