1. Nursing Instruction
  2. Overview
  3. Emergency and Critical
【Major Points】
  1. Migraine and tension-type headaches are the most common, being chronic and recurrent.
  2. Learn methods and techniques to prevent and relieve headaches, and to manage chronic headaches.
  3. Seek medical attention immediately if a headache is accompanied by altered consciousness, blurred vision, or limb weakness.

What is headache?

Headaches are classified as primary or secondary.

  1. Primary headaches: The most common types are migraines and tension-type headaches.
  2. Secondary headaches: These are caused by other conditions, such as fever, head injury, sinusitis, etc.(More information: Care of Patient with Head Injury)
 
What are the common symptoms of headaches?
  1. Primary headaches: often chronic and recurring.
    1. Migraine:
      • Unilateral and throbbing pain (a localized pain combined with a pulsing sensation) that can last for 4 to 12 hours.
      • The pain may worsen with physical activity, bright lights, or noise. Sometimes symptoms like photophobia, nausea, or vomiting may occur.
      • Some people experience an aura before the headache attack, such as feeling depressed, losing appetite, excessive yawning, etc.
    2. Tension headache:
      • Usually near the temples on both sides of the head, caused by tight muscles, feeling like wearing a tight hat or headband.
      • It may worsen when feeling nervous or irritated, but vomiting is less likely to occur.
  2. Secondary headaches:
    1. The underlying cause of the pain needs to be treated, and it usually cannot improve on its own.
    2. You should seek medical attention immediately if your headache is associated with the following symptoms:
      • A headache that worsens over time or a sudden, severe headache (the worst headache ever).
      • Fever combined with a stiff neck and pain.
      • Sudden change in the state of consciousness, such as fainting, slurred speech, drowsiness, or incoherent speech.
      • Unsteady gait, weakness or numbness in the limbs, or even loss of sensation.
      • Visual impairment, such as sudden loss of vision, visual blockage, blurred vision, or double vision.
 
What should I pay attention to?

  1. How to prevent headaches?
    1. Avoid substances or foods that may trigger headaches, such as alcohol, chocolate, cheese, and excessive caffeine.
    2. Keep a headache diary to record triggers or improvements, which can help manage headaches.
    3. Engage in mild regular exercise, such as aerobic exercise or yoga, to prevent or reduce chronic headaches.
    4. Maintain good sleep habits.
  2. How to relieve the pain?
    1. Rest quietly: Find a quiet, dark place to lie down and rest, especially during a migraine attack.
    2. Head massage: Gently massage the scalp if there are no wounds.
    3. Cold/Hot compress: Apply a cold compress to your forehead, and stop if the pain worsens. Use a warm compress to relieve tension headaches.
    4. Practice relaxation techniques: Engage in mindfulness activities, gentle stretching, etc.
    5. Stay hydrated: Dehydration can easily trigger or worsen headaches.
  3. Medical approach: When experiencing recurrent chronic pain, it is advisable to visit a neurologist.
    Provide the following information to your physician:
    1. When did the headache start? How severe is the pain? How long does it last? How often does it occur?
    2. Is the headache unilateral or bilateral?
    3. Are there any associated symptoms?
    4. What worsens the headache? What relieves it?
    5. Is there a family history of migraines (Does anyone else in your family suffer from migraines)?
    6. What triggers the headaches?
  4. Take your medication as prescribed and do not stop abruptly or self-medicate with painkillers. The selection of medications for the prevention and treatment of headaches will be based on the symptoms, associated conditions, side effects, cost, and patient preferences.

References
  1. Ailani, J., Burch, R. C., Robbins, M. S., & Board of Directors of the American Headache Society. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021-1039. https://doi.org/10.1111/head.14153
  2. Fernández-de-Las-Peñas, C., Florencio, L. L., Plaza-Manzano, G., & Arias-Buría, J. L. (2020). Clinical reasoning behind non-pharmacological interventions for the management of headaches: A narrative literature review. International Journal of Environmental Research and Public Health, 17(11), 4126. https://doi.org/10.3390/ijerph17114126
  3. Giamberardino, M. A., Affaitati, G., Costantini, R., Guglielmetti, M., & Martelletti, P. (2020). Acute headache management in emergency department. A narrative review. Internal and Ｅmergency Ｍedicine, 15(1), 109-117. https://doi.org/10.1007/s11739-019-02266-2
  4. Peng, T.R., & Wu, T. W. (2020). Recent advances in migraine treatment. Journal of Internal Medicine of Taiwan, 31(5), 325-332. https://doi.org/10.6314/JIMT.202010_31(5).06
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    Self-care / Home Care
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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