Headaches

• Headaches originate from nerves within the scalp, face, blood vessels & muscles of the neck
• Tension Headaches


  Caused by stress, altered cortisol levels and/or depression

  • Thus causes tension within face & head
  • Make up majority of HA
  • Both sides of head, from back to front - dull or squeezing pain
  • Management includes aspirin, acetaminophen or ibuprofen
• Migraine Headaches


  Complex - may be caused by minor instability within certain clusters of neurons & changed in blood vessels size at the base of brain

  • pt may report an aura
  • Pain is unilateral & focused, becoming more diffused as it progresses
  • Pain is throbbing, pounding, pulsating - may have N/V
  • Pt may want to remain in the dark (photophobia) & quiet environment
  • Can last several days
  • Meds include: beta blockers, Ca channel blockers, antidepressants, serotonin-inhibiting drugs
• Cluster Headaches


  Rare vascular HA - starts at the face as minor pain around one eye.

  • Pain is sharp & excruciating - as if someone was pushing eye out - quickly intensifies & spreads to one side of face
  • HA happens in groups/clusters that last 30-45 min each
  • HA can recur for days then stop entirely - may come back same time next day or month
  • Serotonin & histamine may play a role in causing these HA
  • Meds: antihistamines, corticosteriods, Ca channel blockers
• Sinus Headaches


  Caused by inflammation or infection within the sinus cavities of the face

  • Pain is in the superior portions of the face and inc. when the pt bends over
  • Often worst on waking - may be accomponied by postnasal drip, sore throat, & nasal discharge
• Management


  Be cautious - HA may indicate a more serious condition such as stroke

  • Ask what medications were taken - determine how much
  • Medications for pain management
  • Morphine (2-4mg slow IVP)
  • Fentanyl (50mcg)
  • Medications for N/V: Ondansetron (Zofran 4mg IVP/orally disintegrating tablet)