■ Other primary headaches (e.g., exertional headaches, hypertension-related headaches) (Silberstein et al., 2005)
Each of these headache types has diagnostic criteria and recommended treatments. Most patients who seek care for headache pain have a headache type that is chronic and has elements that are disruptive to their lifestyle and functionality. Many patients feel that the headache pain has a significant impact on the patient's personal life, relationships, and ability to work. The cyclical nature of some of the headache types contributes to patients fearing the unexpected recurrence of the headache at an inopportune time, when they really need to be able to function at full capacity. The disabling characteristic of the headache pain is something that patients learn to expect and fear.
When treating a patient who presents with a headache, all other sources of head pain should be considered and ruled out.
These conditions include brain tumor and other anatomic abnormalities such as Chari I malformations and syringomyelia, infection such as meningitis, and injuries such as subarachnoid bleed. Using magnetic resonance imaging (MRI), computed tomography, lumbar puncture, and electromyography testing can help to rule out other causes of headache and help with the diagnosis of migraine headache (American Society for Pain Management Nursing [ASPMN], 2009).
To diagnose a patient with headache, begin with a complete history and physical examination that delineates the clinical features and presentation of the headache. Seek information on how often the headaches occur, on triggers, and on pain type. Include a description of when the patient had the first headache, location severity, quality, frequency, duration, and what techniques relieve the pain. Ask about any family members who may have similar complaints. Take a complete medication history, including those medications that have been tried and found both effective and ineffective—include dose and length of time used here. Identify any accompanying symptoms, such as nausea or photophobia, or any triggering symptoms, such a specific food or smells. Ask the patient about the use of any types of nonpharmacologic interventions, such as self-hypnosis or relaxation techniques.
For the physical examination, conduct a full neurologic workup, including a funduscopic assessment, cranial nerves, reflexes, and muscle strength, noting neurologic impairment. Ask the patient about any changes in speech, memory, or mental status. As a final point, ask the patient about how the headache affects functionality, ability to work, sleep, or interpersonal interactions. Once the examination is complete and the diagnosis is made, the patients will need education of how best to prevent and treat the headache type he or she is experiencing.
Of the four major types of primary headache, perhaps the most discussed is the migraine headache. There is a great deal of literature on the topic. Migraineurs and CDH patients account for a high proportion of the total headache populations. Cluster headaches and other primary headaches, such as exertional headaches, account for far less of the headache population.
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