Microsoft word - headaches.doc

Headache can be classified into two broad categories: primary and secondary.
Primary headaches include cluster and tension headaches.
Secondary headaches are triggered by an underlying disorder – such as infection, injury or a
Headaches can have more than one contributing factor the muscles and skin of the head, neck and shoulders the nerves of the head and neck the arteries leading to the brain the membranes and disorder of the ear, nose and throat stress (physical or emotional) muscular tension dental or jaw problems infections – ear, nose and throat diet – poor, dehydration (affects blood pressure), low riboflavin (cranberry juice), food additives, such as MSG (monosodium glutamate), naturally occurring chemicals in foods, such as amines (cheese, chocolate, fish that had previously been frozen and vacuum packed meats), fluctuations in blood-sugar levels, which can lead to spasm of the arteries in the head excess or withdrawal (caffeine, alcohol, sugar etc) hormonal influences medications – nitro-glycerine patches, pill, HRT etc lack of exercise disorders of the nervous system injury to the head, neck or spine high blood pressure poor posture – puts unnecessary strain on the muscles of the back and neck hangover from abuse of alcohol or drugs temperature – extremes of heat or cold noise – especially loud noises temporal arteritis – inflammation of the artery at the temple, most common in elderly people meningitis, brain tumors, cerebral bleeds - persistent headache should always be investigated by a doctor 15 percent of us take pain-relieving medication for a headache
Tension headache is the most common type of headache. Two out of three people will have at
least one tension headache in their lifetime
, which is best treated by making lifestyle
adjustments, such as exercise, diet, stress management and attention to posture.
Treatment may include correcting the bite, replacing missing teeth or using occlusal splints,
which allow the jaw to close without dental interference. Surgery may be needed in severe cases.
Tooth decay, dental abscesses and post-extraction infection can cause headache, as well as
referred pain to the face and head, and these need to be professionally treated by a dentist The cause of cluster headaches is uncertain but may be due to a sudden release of the chemicals
histamine and serotonin in the brain - cigarette smoking, alcohol, and some foods (for example,
chocolate and foods high in nitrites like smoked meats) Migraines – immigran etc pre/post meds Acupuncture, physio, chiro, dietitian, exercise, massage etc. Location and
Generalised. Often accompanied by runny nose and sore eyes. symptoms:
Precipitating factors:
Seasonal - allergens, such as pollens, can trigger hay fever and May include anti-histamine medication and decongestant nasal sprays. Altitude Sickness
Location and
Headache is the most frequent complaint of climbers who ascend to symptoms:
high altitudes without oxygen support. Commonly affects both sides of the head, but is limited to one side in about one-quarter of cases. Precipitating factors:
May be prevented in some instances by taking drugs that alter salt and Aneurysm
Location and
Sudden, severe onset (‘thunderclap') of pain. In early stages, may symptoms:
mimic migraine or cluster headaches. Symptoms may also include loss of consciousness, a stiff neck, and double vision. Precipitating factors:
Family history, uncontrolled hypertension. Urgent hospital treatment should be sought. Treatment may include surgery, and medication to keep blood pressure under control. Arthritis
Location and
Pain at the back of head and upper neck. Often made worse by symptoms:
Precipitating factors:
Bony changes in the structure of the neck. May be relieved by anti-inflammatory drugs Brain Cancer / Tumor
Location and
Severe headaches, progressively becoming worse. It is rare that a symptoms:
headache is the only symptom the patient has -other symptoms may include vomiting, visual disturbances, a weakness in an arm and/or leg, speech problems, personality changes or epileptic fits. Precipitating factors:
Treatment may include chemotherapy, radiation therapy, surgery, or some combination of these. Chinese Restaurant Syndrome
Location and
Sensations of pressure and tightness in the face, burning over the symptoms:
trunk, neck and shoulders; pressing pain in the chest. Headache is a pressure or throbbing over the temples and a band like sensation around the forehead, coming on 20-25 minutes after eating Chinese food and lasting for an hour. Precipitating factors:
About 3 grams of MSG (monosodium L-glutamate) will affect sensitive individuals, contained in about 200 millilitres of wonton soup. Avoid food containing MSG- ask before ordering which items on the menu contain MSG. Chronic Daily Headache
Location and
Pain is all over head, diffuse and dull, every day. There may be symptoms:
additional migraine attacks. Usually occurs in 30s and 40s. General feeling of being unwell. Types of CDH are Transformed Migraine, New Persistent Daily Headache and Hemicrania Continua. Precipitating factors:
Daily recurrence can be the result of associated anxiety and depression, or may be associated with overuse of medication. Relaxation therapy, psychological counselling, amitriptyline, non- steroidal anti-inflammatory drugs. Read more about chronic daily headache at Virtual Medical Centre. Chronic Migraine
Location and
See Chronic Migraine. symptoms:
Precipitating factors:
Read more about chronic migraine at Virtual Medical Centre. Chronic Paroxysmal Hemicrania (CPH)
Location and
A variant of cluster headache, however shorter in duration but more symptoms:
frequent, from 6 up to 20 attacks per day. While for cluster headaches men are more affected, it is women who are more affected by CPH. Precipitating factors:
See cluster headache. Frequent daily episodes of CPH almost always respond to the use of 25-50mg of indomethacin taken three times daily. Cluster Headache
Location and
Severe pain centred around one eye. May include drooping eyelid, symptoms:
watering eye and nasal congestion. Most frequently affects males. May be episodic or chronic. Precipitating factors:
During acute attacks, treatment may include oxygen inhalation, sumatriptan subcutaneous injection, ergotamine and intranasal lignocaine. Preventative medications may include calcium channel blockers, lithium, ergotamine, methysergide and corticosteroids. Click here for detailed information on Cluster Headaches
Cough Headache
Location and
A variation on exertional vascular headache, felt only when coughing, symptoms:
sneezing, bending or straining (including during a bowel movement). Precipitating factors:
In small number of people an obstruction blocking the flow through the normal fluid channels of the brain (the ventricles). In older patients, narrowing of the carotid arteries should be excluded. Warrants a consultation with a general practitioner and/or neurologist to rule out structural abnormality. Benign form can be presented by use of indomethacin or a beta-blocking agent such as propranolol. May improve without treatment.
Headache & Dehydration
Location and
Generalised headache – headaches are one of the symptoms of symptoms:
Precipitating factors:
Dehydration is caused by a lack of fluid intake or excess fluid losses. You are most likely to lose fluid through vomiting, diarrhoea, sweat and urine. Many cases of dehydration are caused by: heat, vomiting and diarrhoea (i.e. ‘gastro'), fever, vigorous exercise or strenuous activity, alcohol consumption (alcohol acts as a diuretic), travel (travellers' diarrhoea, long-haul flights – dry cabin conditions, sun exposure, physical activities and alcohol consumption) or lack of food/fluid intake. Under normal circumstances a ‘good hydration status' can be adequately achieved with water and a balanced diet. However, if you are at risk of dehydration, an oral rehydration solution (Hydralyte™) will have some advantages, including - Rehydration is likely to be more rapid - The retention of water is better. - Hydralyte™ is a pleasant flavoured solution, which can be more palatable than plain water, and this can make it easier for you to consume an adequate amount of fluid daily. Click here for more information from Hydralyte Exertional Vascular Headache
Location and
Generalised head pain of short duration (minutes to an hour) during or symptoms:
following physical exertion. Precipitating factors:
Sport, exercise, sexual intercourse. Can usually be prevented by taking suitable medication, such as ergotamine tartrate or indomethacin, before the exercise starts.
Location and
Pain and feeling of heaviness around the eyes. symptoms:
Precipitating factors:
Uncorrected visual problems. An eye test: wearing appropriate glasses or contact lenses will often resolve the problem. Location and
Dull generalised headache. symptoms:
Precipitating factors:
Lowered blood sugar level. Eat regular nutritious meals. Just because a headache regularly occurs in the early hours of the morning does not mean that it is caused by low blood sugar. And it is not likely to be prevented by eating before going to bed. Location and
Generalised pain, ranging from mild to severe, depending on the symptoms:
underlying illness. If accompanied by nausea and vomiting, a stiff neck and/or rash, urgent medical treatment is required. Precipitating factors:
Viral or bacterial infection. Depending on the underlying illness, treatment may include antibiotics and pain relief. If bacterial meningitis/meningococcal disease is suspected, the patient should be taken without delay to the nearest hospital emergency department, or doctor.
Goggle Headache
Location and
So-called because the nerves running from the orbit over the forehead symptoms:
are compressed in swimmers wearing tight-fitting goggles. Precipitating factors:
Constant pressure on the nerves of the scalp. Such headaches can be prevented by changing the position of the goggles each day or using goggles with a single soft-rubber rim that fits around both ends and does not require a very right head strap in order to be watertight.
Location and
Migraine-like symptoms of throbbing pain and nausea not localised to symptoms:
Precipitating factors:
Alcohol, the breakdown products of which cause dilation and irritation of the blood vessels of the brain and surrounding tissue. Treat with liquids (including broth and an oral rehydration solution - Hydralyte™). Consumption of fructose (honey, tomato juice are good sources) to help burn alcohol. Drink alcohol only in moderation.
Location and
Severe, migraine-like headaches experienced by women. symptoms:
Precipitating factors:
Fluctuations in hormonal levels around the time of menstruation or ovulation and/or in the years leading to the menopause; also experienced by some women starting oral contraceptives. See Headache and Adults and Treatment of Headache.
Hot-Dog Headache
Location and
Dilatation (expansion) of the blood vessels inside the skull leads to symptoms:
moderately severed headache. Precipitating factors:
Nitrites in cured foods such as hot-dogs, salami, bacon and ham. Eliminate offending foods from the diet. Location and
Migraine-like headache, more common in young women. symptoms:
Precipitating factors:
May be triggered by fasting, skipping meals, or oversleeping (and thus Eating regular, nutritious meals.
Location and
An all-over pressure or "hair band" type pain, most severe in the symptoms:
morning and diminishing through the day. May feel depressed and generally unwell. Can affect any age person and usually occurs daily. Precipitating factors:
A sudden increase in blood pressure may cause the headache but there are no symptoms of slightly elevated blood pressure. Don't smoke, have an active lifestyle, relax, eat less salt and fat, have your blood pressure checked by tour doctor who may prescribe blood pressure medication. Have your blood pressure tested regularly.
Ice-Cream Headache
Location and
Sharp pain in front of head - centre of forehead or in one temple - symptoms:
immediately after swallowing ice cream or a very cold drink. Occasionally may produce pain behind the ear. Precipitating factors:
Localised pain in the palate or throat from holding ice or ice cream in the mouth or swallowing it while still very cold may refer pain to the head through the trigeminal nerve endings or the glossopharyngeal nerve. More severe and typical migraine suffers are more likely to be prone to ice-cream headache. Don't eat ice cream or have drinks that are very cold.
Idiopathic Intracranial Hypertension (IIH)
Location and
A disorder of elevated spinal fluid pressure in the brain. IIH headaches symptoms:
may be dull, are often at the back of the head, and tend to be worse at night or first thing in the morning. Precipitating factors:
Tends to affect overweight individuals, especially after recent weight gain, even during pregnancy. Certain medications can also predispose individuals to the syndrome, including the antibiotic tetracycline, steroids (as they are weaned off) and vitamin A. Some people may be predisposed to IIH because of being born with a narrowed vein that drains blood from the brain; a condition that was in place since birth. Medications to reduce the spinal fluid pressure or repeated lumbar punctures to keep the pressure down to a safe and tolerable level. Weight loss can cure the condition; nutritionists, medications, and weight-loss programs are often helpful. The sheath surrounding the optic nerves is sometimes surgically opened with small holes to relieve pressure and prevent deterioration of vision. In severe cases, an implantable tube (shunt) that drains the spinal fluid out of the brain needs to be surgically placed. Click here for detailed information on Idiopathic Intracranial
Location and
Mild frontal headache. symptoms:
Precipitating factors:
Analgesics. Stopping use.
Location and
Severe, one-sided throbbing pain, often accompanied by nausea, symptoms:
vomiting, cold hands, sensitivity to sound, light and smells. Migraine with aura may include visual disturbances, numbness in arm or leg. May last from part of a day to three or four days. Onset in childhood, teens and 20s, usually through to 40s/50s, but may last into 60s and beyond. Precipitating factors:
Many triggers, including dehydration, certain foods, insufficient food, hormones, environmental such as sudden changes in weather, oversleeping or too little sleep, physical factors such eye, dental problems, over-exertion or strenuous exercise, certain medications. See Treatment of Headache and Migraine. Click here for detailed information on Migraines
Post-traumatic Headache
Location and
Can be localised or generalised pain, can mimic migraine or tension- symptoms:
type headache symptoms. Headaches may occur on daily basis and are frequently resistant to treatment. Precipitating factors:
Pain can occur after relatively minor traumas. Possible treatment by use of anti-inflammatory drugs, or biofeedback.
Rebound or Withdrawal Headache
Location and
Throbbing headache caused by rebound dilation of the blood vessels. symptoms:
Precipitating factors:
Overusing and then coming off medication such as ergotamine (which constricts the blood vessels) can actually lead to headache. Caffeine and nicotine have the same effect. Avoid excess consumption.
Temporomandibular Joint Dysfunction (TMJ)
Location and
A muscle-contraction type of pain, sometimes accompanied by painful symptoms:
"clicking" sound on opening the jaw. An infrequent cause of headache. Precipitating factors:
Malocclusion (poor bite), stress, and jaw clenching. Relaxation, biofeedback, use of bite plate and in some cases, dental treatment – correction of malocclusion.
Temporal Arteritis
Location and
A burning or boring pain caused by inflammation of the blood vessels in symptoms:
the scalp, particularly the arteries in the temple. Pain is often around jaw muscles when chewing. May be accompanied by redness, swelling, and tenderness of the arteries in the scalp. Generally affects people over 55. Precipitating factors:
Early diagnosis and treatment with steroids essential, as may lead to
Tension-type Headache
Location and
A dull, non-throbbing pain, frequently bilateral, associated with symptoms:
tightness of scalp or neck. Degree of severity remains constant. Precipitating factors:
Emotional stress, hidden depression. Avoidance of stress. Use of biofeedback, relaxation techniques, psychotherapy, and treatment with tricyclic antidepressant medication. Treat with rest, aspirin, ibuprofen, naproxen sodium, ice packs, and muscle relaxants. Click here for detailed information on Tension-type headaches
Thunderclap Headache
A sudden onset of severe headache that can be caused by migraine, orgasm, or a rapid elevation of blood pressure but a cerebral haemorrhage must be excluded (see Aneurysm).
Transformed Migraine

Location and
Typical episodic migraine may increase in frequency to the point where symptoms:
it recurs daily. Precipitating factors:
May be caused by emotional disturbance or the daily dosage of ergotamine or analgesics. A combination of approaches, including the attainment of a calm, relaxed state, the establishment of a satisfactory pattern of living, with regular daily exercise and the right balance of work and leisure time, and the use of tricyclic medication.
Trigeminal Neuralgia (TN, Tic Douloureux)
Location and
Any ache that arises from a nerve is called neuralgia. The trigeminal symptoms:
nerve supplied the face and the front part of the brain. Spontaneous discharge of the trigeminal nerve causes sudden, severe stabbing pains in the cheek and upper gum, or in the jaw and lower gum, known as trigeminal neuralgia. Usually affects older people and women more than men. Recurs irregularly. Precipitating factors:
Since branches of the trigeminal nerve are responsible for conveying pain sensation from the eye and sinuses, disease of these structures may cause a headache in the centre of the forehead. The trigeminal nerve can become infected by the virus of shingles (herpes zoster virus). Compression or irritation of the nerve fibres, commonly caused by the progressive lengthening of a branch of an artery as it hardens with age, multiple sclerosis, and malocclusion. Medication such as anti-epileptic drugs, surgery, dental treatment. Vestibular migraine (VM)
Vestibular migraine (VM) is a headache disorder in which typical migraine headaches occur with dizziness, vertigo and/or imbalance. Other names for VM include migrainous vertigo, migraine-related vestibulopathy, and migraine-related dizziness.


General guidelines for agitated patients in palliative care

Symptom Management Pocket Guides: DELIRIUM DYSPNEA NAUSEA & VOMITING PAIN LOSS OF APPETITE BOWEL CARE ORAL CARE August 2010/July 2012 Table of Contents ESAS…………………………….………….97 Click on hyperlink to go to specific symptom. Delirium Considerations ……………………….…… 1 Assessment ………………………………… 2 Diagnosis ……………………………………. 3 Non-Pharmacological treatment 3 Pharmacological treatment …….… 5 Mild Delirium………………………….…. 6 Moderate Delirium………………….… 6 Severe Delirium ……………………….… 7 Adverse Effects …………………………. 7 Selected References …………………. 9


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