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)
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)
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.
Generalised. Often accompanied by runny nose and sore eyes.
Seasonal - allergens, such as pollens, can trigger hay fever and
May include anti-histamine medication and decongestant nasal sprays.
Headache is the most frequent complaint of climbers who ascend to
high altitudes without oxygen support. Commonly affects both sides of the head, but is limited to one side in about one-quarter of cases.
May be prevented in some instances by taking drugs that alter salt and
Sudden, severe onset (‘thunderclap') of pain. In early stages, may
mimic migraine or cluster headaches. Symptoms may also include loss of consciousness, a stiff neck, and double vision.
Family history, uncontrolled hypertension.
Urgent hospital treatment should be sought. Treatment may include
surgery, and medication to keep blood pressure under control.
Pain at the back of head and upper neck. Often made worse by
Bony changes in the structure of the neck.
May be relieved by anti-inflammatory drugs
Brain Cancer / Tumor
Severe headaches, progressively becoming worse. It is rare that a
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.
Treatment may include chemotherapy, radiation therapy, surgery, or
some combination of these.
Chinese Restaurant Syndrome
Sensations of pressure and tightness in the face, burning over the
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.
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
Pain is all over head, diffuse and dull, every day. There may be
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.
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.
See Chronic Migraine.
Read more about chronic migraine at Virtual Medical Centre.
Chronic Paroxysmal Hemicrania (CPH)
A variant of cluster headache, however shorter in duration but more
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.
See cluster headache.
Frequent daily episodes of CPH almost always respond to the use of
25-50mg of indomethacin taken three times daily.
Severe pain centred around one eye. May include drooping eyelid,
watering eye and nasal congestion. Most frequently affects males. May be episodic or chronic.
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
A variation on exertional vascular headache, felt only when coughing,
sneezing, bending or straining (including during a bowel movement).
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
Generalised headache – headaches are one of the symptoms of
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
Generalised head pain of short duration (minutes to an hour) during or
following physical exertion.
Sport, exercise, sexual intercourse.
Can usually be prevented by taking suitable medication, such as
ergotamine tartrate or indomethacin, before the exercise starts.
Pain and feeling of heaviness around the eyes.
Uncorrected visual problems.
An eye test: wearing appropriate glasses or contact lenses will often
resolve the problem.
Dull generalised headache.
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.
Generalised pain, ranging from mild to severe, depending on the
underlying illness. If accompanied by nausea and vomiting, a stiff neck and/or rash, urgent medical treatment is required.
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.
So-called because the nerves running from the orbit over the forehead
are compressed in swimmers wearing tight-fitting goggles.
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.
Migraine-like symptoms of throbbing pain and nausea not localised to
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.
Severe, migraine-like headaches experienced by women.
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.
Dilatation (expansion) of the blood vessels inside the skull leads to
moderately severed headache.
Nitrites in cured foods such as hot-dogs, salami, bacon and ham.
Eliminate offending foods from the diet.
Migraine-like headache, more common in young women.
May be triggered by fasting, skipping meals, or oversleeping (and thus
Eating regular, nutritious meals.
An all-over pressure or "hair band" type pain, most severe in the
morning and diminishing through the day. May feel depressed and generally unwell. Can affect any age person and usually occurs daily.
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.
Sharp pain in front of head - centre of forehead or in one temple -
immediately after swallowing ice cream or a very cold drink.
Occasionally may produce pain behind the ear.
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)
A disorder of elevated spinal fluid pressure in the brain. IIH headaches
may be dull, are often at the back of the head, and tend to be worse at night or first thing in the morning.
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
Mild frontal headache.
Analgesics. Stopping use.
Severe, one-sided throbbing pain, often accompanied by nausea,
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.
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
Can be localised or generalised pain, can mimic migraine or tension-
type headache symptoms. Headaches may occur on daily basis and are frequently resistant to treatment.
Pain can occur after relatively minor traumas.
Possible treatment by use of anti-inflammatory drugs, or biofeedback.
Rebound or Withdrawal Headache
Throbbing headache caused by rebound dilation of the blood vessels.
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)
A muscle-contraction type of pain, sometimes accompanied by painful
"clicking" sound on opening the jaw. An infrequent cause of headache.
Malocclusion (poor bite), stress, and jaw clenching.
Relaxation, biofeedback, use of bite plate and in some cases, dental
treatment – correction of malocclusion.
A burning or boring pain caused by inflammation of the blood vessels in
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.
Early diagnosis and treatment with steroids essential, as may lead to
A dull, non-throbbing pain, frequently bilateral, associated with
tightness of scalp or neck. Degree of severity remains constant.
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
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).
Typical episodic migraine may increase in frequency to the point where
it recurs daily.
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)
Any ache that arises from a nerve is called neuralgia. The trigeminal
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.
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.
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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