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. As we learn, it is our duty and responsibility to improve ourselves in dealing with patients having disease. This case study aims to identify the defining characteristics of chronic tension type headache, and its signs and symptoms in order to gain knowledge about the disease and provide quality nursing care to the patient’s inflicted by it. Specific Objectives ◦ ◦ ◦ To identify risk factors why this type of disease arises and also to identify risk areas and situations that is prone to chronic tension type headache To promote awareness to the public regarding the incidence of chronic tension type headache To have an idea of specific programs that we can suggest to the authorities to lessen the events of chronic tension type headache cases, and therefore improve the quality of life. ◦ To know specific management and immediate interventions that we can apply whenever we encountered this type of disease.
INTRODUCTION Case Definition Tension headaches are the most common type of primary headaches among adults. They are commonly referred to as stress headaches. Tension headaches are similar to migraine in many respects, although the location of the headache may be somewhat different and the cause is more obvious. Prolonged nervous tension often seems to produce a spasm of the muscles in the back of the neck, particularly in certain people. This muscles spasm draws the tissues over the surface of the cranium very tight, so the pain is felt not only in the back of the neck, but also over the top and front of the head as well. This is a steady, aching type of pain. Usually there is no nausea, vomiting, or flashing lights, for the problem does not appear to affect the brain but is due to external causes. Tension-type headaches account for nearly 90% of all headaches. Approximately 3% of the population has chronic tension-type headaches. A tension headache may appear periodically ("episodic," less than 15 days per month) or daily ("chronic," more than 15 days per month). An episodic tension headache may be described as a mild to moderate constant band-like pain, tightness, or pressure around the forehead or back of the head and neck. These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day. The "severity" of a tension headache increases significantly with its frequency. Chronic tension headaches come and go over a prolonged period of time. The pain is usually throbbing and affects the front, top, or sides of the head. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches do not affect vision, balance, or strength. Tension headaches usually don't keep a person from performing daily tasks.
They have recently been renamed "tension-type headaches" because of the possible role researchers now believe that the chemistry in the brain may play in their origin. approximately 3% suffer from chronic daily tension headaches. and overall these disorders account for approximately 95% of all headache complaints. then.Incidence Headache is a painful and common symptom. TTH can occur at any age. Tension headaches can occur at any age. but they generally strike during adolescence or adulthood. Social. Tension-type headache afflicts more on women than of men living in developed countries. primary headache disorders have a lifetime prevalence of 90% . because the majority of research on headache disorders comes from a limited number of high-income countries. Yet the contribution of lowand middle-income countries to the understanding of headache disorders has not been characterized. . Where studied. but onset during adolescence or young adulthood is common. The symptom is also frequently described as feeling like a rubber band tightly gripping one's head. This sort of headache occurs most often in people between 20 and 50 years of age. Women are twice as likely to suffer from tension-type headaches as men. Little wonder. that tension headaches are the most common kind of all headaches. A number of primary headache disorders have been characterized. It can begin in childhood. The epidemiology and experiences of patients with headache disorders in the developing world are uncertain. About 30%-80% of the adult population suffers from occasional tension headaches. migraine and cluster headache. prevalence and economic burden of headache disorders has been found. including tension-type headache. and patients in resource-poor settings could presumably experience an even greater impact of these inﬂuences. Migraine on its own ranks among the top 20 causes of years of life lived with disability. regional variation in the incidence. One study found that almost 90 percent of women and about 70 percent of men experience tension headaches are estimated to suffer from the dull pressure and aches caused by tension-type headaches at some time in their lives. ﬁnancial and cultural factors can all inﬂuence the experience of the individual headache sufferer. Where sought.
which is demonstrated by a heightened sensitivity to pain in people who have tension headaches. tension or stress.Most people with episodic tension headaches have them no more than once or twice a month. . Chronic tension headaches tend to be more common in females. This muscle tension may be caused by: • • • • • • • Inadequate rest Poor posture Emotional or mental stress. This type of headache is not an inherited trait that runs in families. perhaps as a result of heightened emotions. tightened muscles are not part of tension headaches. neck and scalp. Experts used to think that the pain of tension headache stemmed from muscle contraction in the face. In some people. tension headaches are caused by tightened muscles in the back of the neck and scalp. and the cause is unknown. a common symptom of tension headache. including depression Anxiety Fatigue Hunger Overexertion In others. Many people with chronic tension headaches have usually had the headaches for more than 60-90 days. Etiology The exact cause or causes of tension headache are unknown. There is no single cause for tension headaches. The most common theories support interference or "mixed signals" involving nerve pathways to the brain. but the headaches can occur more frequently. may be the result of overactive pain receptors. Increased muscle tenderness. But research suggests that there doesn't appear to be a significant increase in muscle tension in people diagnosed with tension headache.
Daily stress can lead to chronic tension headaches.Tension headaches are usually triggered by some type of environmental or internal stress. and so on. A withdrawal headache then develops if you do not take painkillers each day. social relationships. friends. One of the theories says that the main cause for tension type headaches and . or on most days. You think this is just another tension-type headache. you may take a lot of painkillers for a bad spell of headaches. a further withdrawal headache develops. Examples of stressors include: • • • • • • • • • • • • • Having problems at home/difficult family life Having a new child Having no close friends Returning to school or training. It is a common cause of headaches that occur daily. The most common sources of stress include family. You may end up taking painkillers every day. Your body then becomes used to painkillers. or on most days. work. This is how medication-overuse headache develops. and so you take a further dose of painkiller. For example. Medication-overuse headache is caused by taking painkillers (or triptan medicines) too often for tension-type headaches or migraine attacks. When the effect of each dose of painkiller wears off. preparing for tests or exams Going on a vacation Starting a new job Losing a job Being overweight Deadlines at work Competing in sports or other activities Being a perfectionist Not getting enough sleep Being over-extended (involved in too many activities/organizations) Episodic tension headaches are usually triggered by an isolated stressful situation or a buildup of stress. and school. Until recently it was believed that tension headaches were caused by muscle tension around the head and neck.
for example from the temporal muscle or other muscles. and cerebral cortex) is believed to be involved in the pathophysiology of chronic tension-type headache. Moreover. Evidence for this theory comes from the fact that chronic tension-type headaches may be successfully treated with certain antidepressants such as amitriptyline. • Pressure that makes feel like head is in a vise. Pain or pressure on both sides of head. . thermal and electrical pain thresholds. The view is that the brain misinterprets information. thalamus. and likely other mechanisms are involved. demonstrated by low mechanical. One of the main neurotransmitters which are probably involved is serotonin. However. • Aching pain at temples or the back of head and neck. the analgesic effect of amitriptyline in chronic tension-type headache is not solely due to serotonin reuptake inhibition. • Steady. and recent research has shown that tension headache patients do not have increased muscle tension Another theory is that the pain may be caused by a malfunctioning pain filter which is located in the brain stem. Patients with chronic tension-type headache have increased muscle and skin pain sensitivity. constant feeling of pressure that usually begins in the forehead. Recent evidence for generalized increased pain sensitivity or hyperalgesia in CTTH strongly suggests that pain processing in the central nervous system is abnormal in this primary headache disorder. Although muscle tension may be involved. and interprets this signal as pain. many researchers now question this idea. not throbbing. a dysfunction in pain inhibitory systems may also play a role in the pathophysiology of chronic tension-type headache General Signs and Symptoms Signs of tension headaches include: • A headache that is constant.migraine is teeth clenching which causes a chronic contraction of the temporal muscle. or the back of the neck. Hyperexcitability of central nociceptive neurons (in trigeminal spinal nucleus.
malaise. tenderness. They can last from 30 minutes to several days. Excruciating pain localized to the eye and orbit and radiating to the facial and temporal regions. and fever.• Tension headaches tend to come back. top or sides of the head • Headache occurring later in the day • Difficulty falling asleep and staying asleep • Chronic fatigue • Irritability • Disturbed concentration • Mild sensitivity to light or noise • General muscle aching Other signs and symptoms • • • • • • Can be described as “a weight on top of my head” Steady. But for some people the pain is very bad or lasts a long time. swelling. especially when under stress. pain from a tension headache is not severe and does not get in the way of your work or social life. or back of the neck. Usually. Clnical manifestations associated with inflammation (heat. weight loss. redness. or pain over the involved artery) usually present. constant feeling of pressure usually begins in the forehead. You have chronic tension headaches if they occur at least 15 days a month . The pain is accompanied by watering of the eye and nasal congestion. Cranial arteritis often begins with fatigue. temple. • Tightness around forehead that may feel like a “vise grip” • Mild to moderate pain or pressure affecting the front.
and presently residing at Manila. The headache is making her tired and it is difficult for her to concentrate at work. which prompted her to have a consultation in ADU Hospital. headache still persisted. daily headache. Roman Catholic. Present History 2 weeks prior to consultation patient has been suffering a constant. Married. born on February 28. Filipino citizen. She has seen her Doctor in Marians Hospital about this complaint. . The Doctor diagnosed “stress” and recommended paracetamol three times a day. Nursing History Chief complaint Headache for 15 days. 2011 with a diagnosis of “Chronic Tension Headache”.D as his admitting physician. Past History No previous injuries and serious illness reported. Vicente Falcon M. She consulted in ADU Hospital last July 29.PATIENT’S PROFILE Patient’s data RN is a 42 year old female. The treatment was not effective. 1969.
her religious affiliation is Roman Catholic and she is married to MSN. She is a Highschool Teacher. both NSD. 1969 in Pampanga. a Filipino citizen who resides at Manila.Personal and social history RN is a 42 year old female. OB History She had her first menses when she was 12 years old. She drinks 1 liter of water a day. and also the president of their jeepney’s association. Her father died because of heart attack and her mother died of senility. She eats 1rice per meal. Feeding History She usually eats 3 meals and 1 snack (in the afternoon). Immunization History She was able to receive all childhood immunizations and complete Tetanus Toxoid. She was born on February 28. G2P2. Her husband is a jeepney driver bound in Baclaran-Monumento route. Family Health and Illness History According to RN. the familial disease she knows that they have in their family was hypertension that is on her father’s side. Her only day-offs is Saturdays and Sundays but uses these days working in the house and taking care of her 2 children. She is also fond of eating vegetables and fatty and spicy foods. She has 2 children. She always sleeps around 11 in the evening and wakes up at 5 in the morning. RN has 2 children. She usually works for 10 hours a day around 7:30 am to 5:30 pm. Gordon’s Functional Health Pattern Health Perception Pattern .
It is evident that she is bothered and irritated due to her headache. She is also fond of eating vegetables and fatty and spicy foods. She eats 1rice per meal. Mondays to Fridays. yellowish in color. She always sleeps around 11 in the evening and wakes up at 4 in the morning. kumukunsulta ako kaagad sa doctor. magastos magpakunsulta pero mas magastos kung lumala”. Activity and Exercise Pattern The patient is a highschool teacher. The stool is usually brownish in color. Cognitive Perceptual Pattern She didn’t have any difficulty in understanding. following instructions and formulating sentences. Role relationship Pattern . Nutrition Metabolic Pattern She usually eats 3 meals and 1 snack (in the afternoon). She urinates 3 to 4 times a day.The patient says “Kung may sakit ako. The patient says “nito ngang nakaraang dalawang lingo hirap akong makatulog dahil sumasakit ang ulo ko”. She answers the questions appropriately. The patient says “these past two weeks I cannot concentrate well on my work and even at home because of this headache”. Elimination Pattern The patient usually defecates every other day. She drinks 1 liter of water a day. Sleep and Rest Pattern She usually has 5 hours of sleep. She has no complained of any pain when voiding and defecating. She considers doing household chores every weekend as her exercise. She usually works for 10 hours a day around 7:30 am to 5:30 pm.
Respiratory Cardiovascular Neurologic • • • • • • (-) DOB. Values/Belief Pattern The patient is a Roman Catholic and she has faith in God. Hair is coarse and no parasites.The patient is happily living with her family. pink nails. She usually goes to mass every Sunday with her husband and children. Review of systems SYSTEMS Integumentary ACTUAL FINDINGS • • • Fair complexion Turgor returns 1-2 seconds. she tells it to her husband and prays. According to her she always prays. Coping/ Stress Pattern When she has problems. (-) SOB No murmur BP of 120/90 Presence of weakness Headache Cooperative . She maintains an eye to eye contact during the interview.round and firm. but for the past two weeks hindi na dahil dito sa headache ko”. Hair is black and equally distributed. Self perception/concept Pattern The patient said “ok naman ako eh.
(Normocephalic).7 C P.36. nits and AREAS TO ASSESS SKULL .No tenderness noted upon Scalp Normal palpation. . .Can be moist or oily.68 bpm RR. .Generally round.Gastrointestinal Musculoskeletal Hematologic Endocrine Immunologic Urinary • • • • • • • • No loss of appetite Equal ROM (range of motion) No incidence of bleeding or hemorrhage No heat and cold intolerance No loss of appetite No fever Has no history of Urinary tract infection Has no changes in elimination pattern Physical Assessment Vital Signs: T.No scars noted. .Free from lice. -Lighter in color than the complexion. with prominences in the frontal and occipital area.120/90 HEAD: • • (+) Headache with a pain scale of 7/10 Afebrile ACTUAL FINDINGS Normal NORMAL FINDINGS .15 cpm BP.
-Evenly distributed covers the whole scalp (No evidences of Alopecia) -Maybe thick or thin. Face Normal -Neither brittle nor dry. . -palpebral fissure (distance between the eye lids) equal in both eyes. -bilateral Nasolabial fold (creases extending from the angle of the corner of the mouth). Eyebrows · · · · · · Symmetrical and in line Maybe black. coarse or smooth. Evenly placed and inline Non protruding. -Can be black.No lesions should be noted. Eyes with each other. . blond depending on race. Equal palpebral fissure. brown or burgundy depending on the race. with each other.dandruff. . brown or Evenly distributed. Slight asymmetry in Eyes Normal the fold is normal.No tenderness nor masses on Hair Normal palpation.
. Evenly distributed. (drooping of upper eyelids). · Meets completely when eyes are closed. Conjunctiva Both conjunctivae are pinkish or red in color. · No PTOSIS noted. Eyelids · Upper eyelids cover the small portion of the iris. Turned outward. cornea.Eyelashes · · · Color dependent on race. · No regurgitation from the nasolacrimal duct. · · · · With presence of many Moist No ulcers No foreign objects minutes capillaries. and sclera when eyes are open. · No tenderness on palpation. Lacrimal Apparatus · Lacrimal gland is normally non palpable. · Symmetrical.
brown or green). The cornea is clear or irregularities on the surface. materials. the person’s race (black. the iris should appear flat and should . · There is a positive corneal reflex.Sclerae · · · · Sclerae is white in color No yellowish discoloration Some capillaries maybe Some people may have (anicteric sclera) (icteric sclera). · From the side view. blue. visible. The features of the iris should be fully visible through the cornea. Anterior chamber and Iris · · · The anterior chamber is No noted any visible Color of the iris depends on transparent. transparent. Cornea · · · There should be no Looks smooth. pigmented positions.
and are equal in size. and constrict when looking at nearer objects.not be bulging forward. EARS Normal · The ear lobes are bean shaped. . · Pupils dilate when looking at distant objects. There should be NO crescent shadow casted on the other side when illuminated from one side. Constrict briskly/sluggishly when light is directed to the eye. Pupils · Pupillary size ranges from 3 – 7 mm. both directly and consensual. · Skin is same in color as in the complexion. parallel. · · Equally round. and symmetrical. · No lesions noted on inspection. · The upper connection of the ear lobe is parallel with the outer canthus of the eye. · The auricles are has a firm cartilage on palpation.
. Maybe . -May not be palpable.The nasal mucosa is pinkish to red in color.· The pinna recoils when folded.No tenderness noted on palpation.No flaring alae nasi.No bone and cartilage deviation noted on palpation. · The ear canal has normally some cerumen of inspection. . · On otoscopic examination the tympanic membrane appears flat. -Nose in the midline .No Discharges. · There is no pain or tenderness on the palpation of the auricles and mastoid process. (Increased redness turbinates are typical of allergy). .Both nares are patent. . · No discharges or lesions noted at the ear canal. translucent and NOSE and PARANASAL SINUSES Normal pearly gray in color. . . .Nasal septum in the mid line and not perforated.No tenderness noted on palpation of the paranasal NECK Normal sinuses.
-About less than 1 cm in size. -No fail chest which is suggestive of rib fracture. -The thyroid is initially observed by standing in front of the client and asking the client to swallow. the anteroposterior diameter is less than the transverse diameter at approximately a ratio of 1:2. Palpation of the thyroid can be done either by posterior or anterior approach. -Moves symmetrically on breathing with no obvious masses. -Slightly movable. THORAX Normal -The shape of the thorax in a normal adult is elliptical. -No bulging at the ICS must be noted as this may . -No chest retractions must be noted as this may suggest difficulty in breathing. -Firm with smooth rounded surface.normally palpable in thin clients. -Non tender if palpable.
-No edema -Color is even. -No involuntary movements. -Skin color is uniform. -Some clients may have striae or scar. -No venous engorgement. -There should be no scoliosis. -Expiration is usually longer ABDOMEN Normal the inspiration. or cardiomegaly. with slightly curvature in the thoracic area. or lordosis. -Breathing maybe diaphragmatically of costally. -Contour may be flat. EXTREMITIES Normal -Both extremities are equal in size. rounded or scapoid -Thin clients may have visible peristalsis. -The spine should be straight. -Have the same contour with prominences of joints.obstruction on expiration. -Temperature is warm and . abnormal masses. kyphosis. -Aortic pulsation maybe visible on thin clients. no lesions.
-Can counter act gravity and resistance on RO .even. -No crepitus must be noted on joints. -Has equal contraction and even. -Can perform complete range of motion.
the patient will be able to: Interventions Rationale Evaluation Acute Pain r/t decreased cerebral blood flow secondary to migraine as The patient manifested by verbalized “I feel guarding behavior.” OBJECTIVE CUES: Rated pain as 9 out of 10 Facial grimace Gurading behavior (clutches head and assumes fetal position) Palmar and After 4 hours of Assess To determine contributing underlying cause nursing interventions the patient: factors to pain of pain and treat such as bright accordingly.Assessment SUBJECTIVE CUES: Diagnosis Planning After 4 hours of nursing interventions. like my head is being facial grimace and crumpled from the pallor inside and banged on a hard surface repetitively. Verbalized feeling of lights and strong relief of pain and feel fumes Certain drugs may cause fatigue better Become relieved of and drowsiness. signs and symptoms Review Pain scale 0 out of 10 medication of pain experienced regimen To allow non as Was able to use pharmocological evidenced by: relaxation techniques Provide comfort pain relief and such as deep breathing measures such as promote good Verbalize pain is repositioning the circulation to the relieved (rate pain client in a brain and from 0-4 out of 10) comfortable decrease position and vasoconstriction Demonstrate use of providing a hot diversional or cold compress To decrease activities such as environmental relaxing and/or Provide factors which sleeping calm and quiet contribute to environment headache and promote rest Instruct use of relaxation techniques To distract such as deep attention from pain and breathing decrease tension .
facial pallor .
Provide quiet. there are some complications that may still occur. Even though you feel better. . S (SPIRITUALITY) Keeping faith in God and believing in Him can uplift some distress in the whole family. It’s important to have the doctor monitor his progress.DISCHARGE PLANNING M (MEDICATION) Take the entire course of any prescribed medications. comfortable and peace environment. Proper preparation of food and water to have adequate nutrition and hydration. protein and other necessary nutrients. O (OUT PATIENT FOLLOW – UP) Return to the doctor as frequent as possible to monitor your present condition. H (HOME TEACHING) Encourage nutrition supplements to prevent weight loss. T (TREATMENT) Undergo necessary procedure as needed. Keep all of follow-up appointments. these can also become ways to engage yourself in nutritional health care. Observe safety measure at home to prevent for injuries. E (EXERCISE & ACTIVITY) Have adequate rest and assisted exercises to maintain muscle tonicity and also avoid engaging in extraneous activities to avoid tension headache. D (DIET) Planning meal and having regular family meals can help ensure that you gets enough calories. Observe self for any suspicious condition and notify to your doctor.
This case study does have nursing care management. we can also prevent ourselves in acquiring such disease. As a part of medical team.NURSING IMPLICATIONS Nursing Research This case study is important to nursing research because it opens new opportunity to conduct another research in relation to the disorder even though there are many existing researches with regards to this disorder. Even a single mistake about the information that we give to our client can take away their life. and as a nursing student. student nurses are also an educator to our client. it is an advantage for us to have this case study because it gives us additional and new knowledge about the disorder. We are very prone to acquire this disease because we are always in contact with many clients and due to a tiring job. we should be responsible enough to spread the knowledge about this certain disease to prevent acquiring the disease. We. research will still be a key to discover a better treatment for it. we can be able to give the best quality of care when we encounter a patient with the same disorder. Even if we know that chronic tension headache is still common nowadays. it is important to know everything about a certain disease. Nursing Education In Nursing Education. When we have the knowledge about the disease. Nursing research is our way to have a new knowledge and understanding about the disease that we can use to render the best quality of care for our client. Nursing practice Through the help of this study we can acquire more information’s and knowledge about chronic tension headache. We are the one who is always in contact with our client. . As an educator. It is important that we teach accurate details to our client because they believe on what we say. Knowing that chronic tension headache can be acquired in several ways. As a nursing student. it is very vital for us to be aware for the new researches because we are the primary care giver for our client. Prevention will always be better than cure. This case study will be an essential tool to render the best quality of care that we can render to our client.
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