HEADACHE
vomiting, focal or generalized seizures,
Overview
• the most common neurologic symptom
• may be localized or generalized, producing mild
to severe pain
Brain tumor
• may be described as vascular, muscle-
contraction, or a combination of both
• about 90% are benign
Assessment
History
• Ask about the characteristics and location of the
headache
• Find about precipitating or alleviating factors.
• Obtain a drug and alcohol history.
• Find about recent head trauma, nausea,
Cerebral Aneurysm (ruptured)
vomiting, photophobia, or vision changes
• Ask about associated drowsiness, confusion,
dizziness, or seizures
Physical Assessment
• Evaluate level of consciousness (LOC).
• Check vital signs.
• Be alert for signs of increased intracranial
pressure (ICP).
• Check pupil size and response to light.
Encephalitis
• Note any neck stiffness.
Medical Causes
Brain abscess
• Headache is localized to the abscess site
and intensifies over a few days.
• Straining aggravates headache.
• Accompanying findings include nausea,
changes in LOC and depending on the
location of the abscess, aphasia, impaired
visual acuity, hemiparesis, ataxia, tremors,
and personality changes.
• Headache is localized near the tumor site
but becomes generalized as the tumor
grows.
• Pain is usually intermittent, deep-seated,
dull, and most intense in the morning:
aggravating factors include coughing,
stooping, Valsalva’s Maneuver, and
changes in head position; and alleviating
factors including sitting and rest.
• Other findings include personality changes,
altered LOC, motor and sensory
dysfunction, and signs of increased ICP.
• A life-threatening condition- headache is
sudden and excruciating and usually peaks
within minutes and rupture.
• The patient may lose consciousness
immediately or display a variably altered
LOC.
• Depending on the location and the severity
of the bleeding, other findings may include
nausea, vomiting, nuchal rigidity, blurred
vision and hemiparesis.
• A severe generalized headache is
characteristic.
• Within 48 hours, the patient’s LOC typically
deteriorates.
• Other findings include fever, nuchal rigidity,
seizures, nausea, vomiting, photophobia,
cranial nerve palsies, and focal neurologic
deficits.
Glaucoma (acute angleclosure)
• Excruciating headache as well as acute eye
pain, blurred vision, halo vision, nausea
and vomiting may occur in this opthalmic
emergency.
• Other findings may include conjunctival
injection, a cloudy cornea, and a
moderately fixed, dilated pupil.
Subarachnoid Hemorrhage
Hypertension
• A sever generalized or frontal headache on
awakening may occur; severity decreases
during the day (if diastolic pressure
remains greater than 120mmHg, the
headache is constant).
• Other findings include atrial gallop,
restlessness, confusion, nausea and
vomiting, blurred vision, seizures and
altered LOC.
Subdural Hematoma
Influenza
• A severe generalized or frontal headache,
usually begins suddenly.
• Accompanying findings include stabbing
orbital pain, weakness, myalgia, fever,
chills, coughing, rhinorrhea, and
hoarseness.
Meningitis
• Onset of a severe, constant, generalized
headache is sudden.
• Headache worsens with movement.
• Other findings include altered LOC,
seizures, fever, chills, nuchal rigidty, ocular
palsies, facial weakness, hearing loss,
positive Kernig’s sign and Brudzinski’s signs
and hyperreflexia, opisthotonos, and signs
of increased ICP.
Sinusitis (acute)
• A dull periorbital headache is usually
aggravated by bending over or touching the
face and is relieved by sinus drainage.
• Fever, sinus tenderness, nasal turbinate
edema, sore throat, malaise, cough and
nasal discharge may develop.
• A sudden, violent headache occurs with
nuchal rigidity, nausea and vomiting,
seizures, dizziness, ipsilateral pupil dilation,
and altered Loc that may progress to coma.
• Other findings include positive kernig’s sign
and bruzinski’s sign, photophobia, blurred
vision, fever, hemiparesis, hemiplegia,
sensory disturbances, aphasia and
increased signs of ICP.
• Headache develops and LOC decreases.
• In acute cases, findings include drowsiness,
confusion and agitation that may progress
to coma and later signs if increased ICP and
focal neurologic deficits.
• In chronic cases, pounding headache
fluctuates in severity and is located over the
hematoma.
• Giddiness, personality changes, confusion,
seizures, and progressively worsening LOC
may develop weeks or months after the
trauma.