Download Acute and chronic headache

 Acute and chronic headache
Recommend
 Suspect subarachnoid haemorrhage (SAH) in any patient who presents with a
headache of sudden onset they describe as the most severe headache they have
ever had. Consult MO immediately. See Subarachnoid haemorrhage
Background

Headache can be classified into two broad categories - primary and secondary
 primary headache include migraine, cluster or tension headache
 secondary headaches are triggered by an underlying disorder - such as
infection, injury or tumour, subarachnoid haemorrhage - and can be considered
as a side effect of the main illness
Related topics:
Subarachnoid haemorrhage, page 238
 Snake bite, page 201
 Head injury, page 107
TIA / Stroke, page 235
Meningitis, page 524
1.


May present with:
Primary headache:
 tension headaches are the most common type of headache. Two out of
three people will have at least one tension headache in their lifetime. This
feels like a tight band of pressure around the head and can be caused by
physical or emotional stress
 migraine headache feels like a throbbing or pulsing pain and sometimes
includes other symptoms, such as visual disturbances, numbness of the face
or extremities, nausea and vomiting. It is associated with a spasm of the
blood vessels leading to the brain. Migraines can be triggered by many
different things, including food, stress, heat and cold, strong smells,
emotions, fatigue or hormonal fluctuations.
 cluster headaches usually involve severe pain, localised to one eye and
can include other symptoms, such as swelling and watering of the affected
eye. Are relatively uncommon and tend to mainly affect men. Can be
triggered by alcohol and cigarettes, but the underlying cause is unknown.
Secondary headache is a side effect of:
 head or neck injury
 high blood pressure
 meningitis see Meningitis
 disorders of the nose, ear or throat,
or dental problems e.g. abscesses,
 sinus infection
misaligned teeth.
 brain tumour
 certain medications may also cause
 encephalitis
headaches- e.g. birth control pills,
 haemorrhage
diabetes medication.
 head trauma – (can be
 other physical causes of headache
minor, leads to chronic
include, dehydration, hangover, loud
subdural haematoma)
noise or poor posture, hormonal
 hydrocephalus
causes
 eye diseases


subarachnoid
haemorrhage
 spinal injury
arthritis or inflammation of the
arteries (temporal arthritis)
2.
Immediate management
 If patient distressed, lie patient flat and reassure
3.
Clinical assessment:
 Perform a complete patient history noting current medications, alcohol and other drug use, maybe
snake bite
 Perform standard clinical observations + BGL, Glasgow coma scale / AVPU
 Perform physical examination – inspect skin for rashes
 Specific factors to consider when assessing patient with a headache include:
 location of the pain, such as around one eye or over the scalp
 the degree of pain experienced
 onset and duration of the headache – does patient wake with pain?
 other symptoms, such as visual disturbances, vomiting, a sore neck, fever (meningitis), coordination problems, fits (convulsions), changes in personality and weakness on one side of the
body
 how often the headache recurs
 is the headache progressively worsening
 factors that worsen the headache, such as certain foods
 factors that improve the headache, such as massage
 Consult MO. Persistent headaches need to be medically investigated. Tests can include scans, eye
tests and sinus x-rays
4.
Management:
Treating a headache depends on its cause.
 Treatment for the underlying disorder if the headache is secondary
 Tension headache - lifestyle adjustments, such as exercise, diet, stress management and attention
to posture
 Migraine headache – oxygen, medications and lifestyle modifications, such as identifying and
avoiding factors that trigger an attack
 Cluster headache - medication or oxygen therapy
 Other management techniques include –
 Paracetamol, MO may prescribe other medication
 relaxation techniques, such as massage, stress management
 alterations to the diet
 alternative therapies, such as acupuncture or chiropractic
See Simple Analgesia Protocol (back cover)
5.
Follow up:
 According to underlying cause
 Offer ongoing support and reassurance
6.
Referral/Consultation:
 Consult MO for all secondary headaches. Patients will need referral for further investigation as
appropriate
 Consider referral for counselling and / or stress management for people with primary headaches if
appropriate.