Headache and Fever Headache Learning Objectives • Differentiate between the different types of headaches based upon signs/symptoms and clinical presentation. • Primary HA • 90% of HA • Not associated with underlying illness • Examples • Chronic tension-type HA • Episodic or chronic (chronic = ≥15 days/month for at least 3 months • Migraine HA w/wo aura • Cluster HA • Medication overuse HA • Secondary HA • Symptoms of underlying illness • Examples • Head trauma • Stroke • Substance abuse/withdrawal • Bacterial/viral illnesses • Disorders of craniofacial structures • Describe the pathophysiology for each of the types of headache disorders. • Migraine Headaches • Complex interaction between neuronal and vascular factors • Main locus believed to be activity within trigeminal neurovascular system
• Activation of trigeminal sensory nerves releases vasoactive neuropeptides—substance P, CGRP, Neurokinin A • Leads to vasodilation and dural plasma extravastation inflammation • Vasodilation causes relay of pain impulses to cortical pain centers • Triggers • Stress, fatige, irregular sleep, hormonal changes, everything • Medications • Nitrates, contraceptives, postmenopausal hormones, reserpine • Clinical Presentation • Premonitory symptoms—12-79% of patients –hours to days before migraine • Allodynia (hypersensitive to pain), photophobia, hyperosmia, difficulty concentrating • Aura –25% of patients • Evolves over 5-20 minutes, lasting <60minutes • HA generally occurs w/in 60 min of aura • Usually visual • May also manifest as parasthesias, numbness, weakness, hemiparesis • HA • Gradual in onset, peaks in intensity over minutes to hours • Duration 4-72 hours • Pain usually in frontotemporal region • Usually unilateral and described as throbbing or pulsating • N/V • Other concomitant symptoms • Anorexia, food cravings, constipation, diarrhea, cramps, lburred vision, photophobia, phonophobia • Resolution phase
• Fatigue, irritability, impaired concentration, malaise • Tension Headache • Manifest in response to stress, anxiety, depression • May be acute or chronic • Activation of pain perception structure in brainstem • Central modulation pf peripheral stimuli to pain • Chronic HA evolves from acute, episodic HA • Clinical Presentation • Premonitory and aura symptoms are absent • Pain usually mild-moderate • Dull, nonpulsatile tightness or pressure • Bilateral pain is most common • “hatband” pattern • Associated symptoms generally absent • Shivering/cold temps may make them worse • Sinus Headache • Dull, pressure-like pain in the periorbital, forehead area • Usually patient will have other sinus symptoms • Treated much the same as tension HA • May recommend decongestant products as well • Cluster Headaches • The most severe of the primary HA disorders • Relatively uncommon males 3:1 •
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- Spring '17
- Headaches, migraine, Headache