KWAME NKRUMAH UNIVERSITY OF

SCIENCE & TECHNOLOGY

Medical nursing
NURSING III
HEADACHE
Joana Kyei –Dompim
Department of nursing
joankyeidompim@gmail.com
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KWAME NKRUMAH UNIVERSITY OF
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Lesson Outline
• By the of the lesson students must be able to
1. Describe the structure and function of the nervous system
2. Explain Cells of the nervous system
3. Mention 5 Assessment of NS
4. Describe History taking of the NS
5. Enumerate Diagnostic measures and nursing responsibilities
6. Explain General hx taking of NS
7. Describe the types of headaches

8.
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KWAME NKRUMAH UNIVERSITY OF
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THE NERVOUS SYSTEM
• DIVISIONS OF THE NERVOUS SYSTEM

CNS PNS

- Brain - Cranial Nerves and spinal nerves

- Spinal Cord - Communication lines between the CNS and rest of the body

Sensory (afferent) division Motor (efferent) division

- Somatic or visceral sensory neurons - Motor neurones
- Conducts impulses from reception to CNS - Conduct impulses form the
CNS to effectors (muscle & glands}

Autonomic nervous system Somatic Nervous system

- Involuntary - Voluntary
- Conducts impulses from the CNS - Conducts impulses from the CNS to skeletal muscles
to cardiac, smooth muscles and glands
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Structure and function of the nervous system
• The human nervous system is responsible for the control and integration of the
body’s many activities. The nervous system can be divided into the central
nervous system and the peripheral nervous system.
• The central nervous system (CNS) consists of the brain, spinal cord, and cranial
nerves I and II.
• The peripheral nervous system (PNS) consists of cranial nerves III to XII, spinal
nerves, and the peripheral components of the autonomic nervous system (ANS).
• The nervous system is made up of two types of cells: neurons and glial cells
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Cells of the nervous system
• Neuron - the primary functional unit of the nervous system, comes with different shapes and
size .
• A typical neuron consists of a cell body, multiple dendrites, and an axon.
• Glial Cells. Glial cells (glia or neuroglia) provide support, nourishment, and protection to
neurons.
• Glial cells constitute almost half of the brain and spinal cord mass and are 5 to 10 times more
numerous than neurons.

• Different types of macroglial cells include the astrocytes (most abundant), oligodendrocytes,
and ependymal cells
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Cells of the nervous system
• SUPPORT CELLS (NEUROGLIA OR GLIA)
• Astrocytes. These are abundant, star-shaped cells that account for nearly half of the neural
tissue; astrocytes form a living barrier between the capillaries and neurons and play a role in
making exchanges between the two so they could help protect neurons from harmful
substances that might be in the blood.
• Microglia. These are spiderlike phagocytes that dispose of debris, including dead brain cells
and bacteria.
• Ependymal cells. Ependymal cells are glial cells that line the central cavities of the brain and
the spinal cord; the beating of their cilia helps to circulate the cerebrospinal fluid that fills
those cavities and forms a protective cushion around the CNS.
•
 KWAME NKRUMAH UNIVERSITY OF
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Cells of the nervous system
• SUPPORT CELLS (NEUROGLIA OR GLIA)
• Oligodendrocytes. These are glia that wrap their flat extensions tightly around
the nerve fibers, producing fatty insulating coverings called myelin sheaths.
• Schwann cells. Schwann cells form the myelin sheaths around nerve fibers that
are found in the PNS.
• Satellite cells. Satellite cells act as protective, cushioning cells.
• NB. Schwann and satellites are found in the PNS and the rest in the CNS
•
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Cranial nerves
• I. OFALTORY
• II . OPTIC
• III. OCULOMOTOR
• IV. TROCHLEAR
• V . TRIGEMINAL
• VI. ABDUCENS
• VII. FACIAL
• VIII. VESTIBULOCHOCHLEAR
• IX. GLOSOPHARYNGEAL
• X. VAGUS
• XI .ACCESSORY
• XII. HYPOGLOSAL
MENONICS FOR THE CRANIAL NERVES
• Oh Oh oh To Touch And Feel very Good Velvet, Arrrrhh Heavens!!!!!!
• Try and form your own mnemonics
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Cranial nerves
• Olfactory. Fibers arise from the olfactory receptors in the nasal mucosa and synapse with the
olfactory bulbs; its function is purely sensory, and it carries impulses for the sense of smell.
• Optic. Fibers arise from the retina of the eye and form the optic nerve; its function is purely
sensory, and carries impulses for vision.
• Oculomotor. Fibers run from the midbrain to the eye; it supplies motor fibers to four of the six
muscles (superior, inferior, and medial rectus, and inferior oblique) that direct the eyeball; to
the eyelid; and to the internal eye muscles controlling lens shape and pupil size.
• Trochlear. Fibers run from the midbrain to the eye; it supplies motor fibers for one external eye
muscle ( superior oblique).
• Trigeminal. Fibers emerge from the pons and form three divisions that run to the face; it
conducts sensory impulses from the skin of the face and mucosa of the nose and mouth; also
contains motor fibers that activate the chewing muscles.
•
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Cranial nerves
• Abducens. Fibers leave the pons and run to the eye; it supplies motor fibers to the lateral rectus muscle, which
rolls the eye laterally.
• Facial. Fibers leave the pons and run to the face; it activates the muscles of facial expression and the lacrimal and
salivary glands; carries sensory impulses from the taste buds of the anterior tongue.
• Vestibulocochlear. fibers run from the equilibrium and hearing receptors of the inner ear to the brain stem; its
function is purely sensory; vestibular branch transmits impulses for the sense of balance, and cochlear branch
transmits impulses for the sense of hearing.
• Glossopharyngeal. Fibers emerge from the medulla and run to the throat; it supplies motor fibers to the pharynx
(throat) that promote swallowing and saliva production; it carries sensory impulses from the taste buds of the
posterior tongue and from pressure receptors of the carotid artery.
• Vagus. Fibers emerge from the medulla and descend into the thorax and abdominal cavity; the fibers carry
sensory impulses from and motor impulses to the pharynx, larynx, and the abdominal and thoracic viscera; most
motor fibers are parasympathetic fibers that promote digestive activity and help regulate heart activity.
• Accessory. Fiber arise from the medulla and superior spinal cord and travel to muscles of the neck and back;
mostly motor fiber that activate the sternocleidomastoid and trapezius muscles.
• Hypoglossal. Fibers run from the medulla to the tongue; motor fibers control tongue movements; sensory fibers
carry impulses from the tongue.
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Structure of the neuron
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DIVISION OF THE BRAIN
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Assessment of the nervous system ( subjective data
• Past health history – ensure no leading questions, right frame of mind, mode of
onset of condition .
• Medications -Obtain a careful medication history, especially the use of sedatives,
opioids, tranquilizers, and mood elevating drugs.
• Surgery or other treatment
• Health perception or health mgt practice – substance abuse , smoking , previous
hospitalization for neurological problems
• Nutritional metabolic pattern – problem with chewing , swallowing ,coordination
• Elimination pattern - Bowel and bladder problems are often associated with
neurologic problems such as stroke, head injury
•
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Cont
• Activity-Exercise Pattern. Many neurologic disorders can cause problems in the
patient’s mobility, strength, and coordination Sleep-Rest Pattern. Sleep pattern
alteration can be both a cause and a response to neurologic problems. Pain and
reduced ability to change position because of muscle weakness and paralysis
could interfere with sleep quality
• Self-Perception–Self-Concept Pattern. Neurologic diseases can drastically alter
control over one’s life and create dependency on others for meeting daily needs.
• Cognitive-Perceptual Pattern. Because the nervous system
controls cognition and sensory integration, many neurologic
disorders affect these functions. Assess memory, language, calculation ability,
problem-solving ability, insight, and judgment.
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Cont.
• Role-Relationship Pattern. Physical impairments such as weakness and paralysis can alter or limit
participation in usual roles and activities such as being the caregiver
• Sexuality-Reproductive Pattern. Assess the person’s ability to participate in sexual activity because
many neurologic disorders can affect sexual response. Cerebral lesions may inhibit the desire phase
or the reflex responses of the excitement phase
• Coping–Stress Tolerance Pattern. The physical sequelae of a neurologic problem can seriously
strain a patient’s coping patterns. Often the problem is chronic and requires that the patient learn
new coping skills.

• Value-Belief Pattern. Many neurologic problems have serious, long-term, life-changing effects.
Determine what these effects are, since they can strain the patient’s belief system. Also determine if
any religious or cultural beliefs could interfere with the planned treatment regimen
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General history taking for nervous conditions
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HISTORY TAKING
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HISTORY TAKING
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Assessment of the nervous system ( objective data
• Physical Examination. The standard neurologic examination helps determine the
presence, location, and nature of disease of the nervous system. The examination
assesses six categories of functions:
• mental status ( general appearance , cognition, mood and affect)
• cranial nerve function
• motor function ( finger to nose text, heel to shin )
• sensory function ( touch, pain, temperature vibration n, position sense- Romberg
test )
• cerebellar function
• Reflexes ( biceps, triceps, patellar reflex)
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NORMAL ASSESSMENT OF THE NERVOUS SYSTEM
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NORMAL ASSESSMENT OF THE NERVOUS SYSTEM
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Physical assessment abnormalities
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Physical assessment abnormalities
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Physical assessment abnormalities
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Diagnostic studies of the nervous system
• Cerebrospinal fluid analysis –through lumber puncture or ventriculostomy.
• Computed tomography
• Magnetic resonance imaging
• Cerebral Angiography.
• Electroencephalography.
• Electromyography and Nerve Conduction Studies.
• Myelogram
• Positron emission tomography
• X ray
• Transcranial Doppler
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HEADACHES
• Headache is probably the most common type of pain that humans experience.
• The majority of people have functional headaches, such as migraine or tension-type
headaches.
• The others have organic headaches caused by intracranial or extracranial disease.

• The pain-sensitive structures in the head include venous sinuses, dura, cranial blood
vessels, three divisions of the trigeminal nerve (cranial nerve [CN] V), facial
nerve (CN VII), glossopharyngeal nerve (CN IX), vagus nerve (CN X), and the fist three
cervical nerves.
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CLASSIFICATION OF HEADACHE
• Headaches are classified as primary or secondary headaches.
• Primary headaches are those not caused by a disease or another medical condition. Primary
headache classifications include tension-type, migraine, and cluster headaches.
• The type of primary headache is determined using the International Headache Society (IHS)
guidelines based on characteristics of the headache
• secondary headaches are caused by another condition or disorder, such as sinus infection, neck
injury, and stroke.
• A patient may have more than one type of headache.
• The history and neurologic examination are diagnostic keys to determining the type of
headache
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TYPES OF HEADACHES & TECHNOLOGY
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TENSION-TYPE HEADACHE
• Tension-type headache, also called stress headache, is the most common type of
headache.
• These headaches are characterized by their bilateral location and pressing or
tightening quality.
• Tension-type headaches are usually of mild or moderate intensity and can last from
minutes to days.
• Tension-type headaches are divided by frequency into episodic and chronic types.
 KWAME NKRUMAH UNIVERSITY OF
Causes SCIENCE & TECHNOLOGY
• Although the cause of tension-type headaches is not fully understood, the
development of this type of headache is believed to be associated with
neurovascular factors similar to those involved in migraine headaches. Many
patients gradually progress over years from episodic to chronic headaches, with
the increasing frequency associated with increasing intensity of the headache
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Clinical manifestations
• Patients usually are initially seen with a bilateral frontal-occipital headache
described as a constant, dull pressure, or band like headache associated with
neck pain and increased tone in the cervical and neck muscles. The headache
may involve sensitivity to light (photophobia) or sound (phonophobia), but does
not involve nausea or vomiting.
• There is no prodrome (early manifestation of impending disease), and physical
activity does not aggravate symptoms.
• The headaches may occur intermittently for weeks, months, or even years. Many
patients can have a combination of migraine and tension-type headaches, with
features of both occurring simultaneously.
• Patients with migraine headaches may experience tension-type headaches
between migraine attacks.
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DIAGNOSTIC STUDIES
• History taking –increased resistance to passive movement of the head and
tenderness of the head and neck may be present.
• Electromyography (EMG) may reveal sustained contraction of the neck, scalp, or
facial muscles.
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MIGRAINE HEADACHE
• Migraine headache is a recurring headache characterized by
unilateral (sometimes bilateral) throbbing pain, a triggering event or factor, and
manifestations associated with neurologic and autonomic nervous system
dysfunction. The most common age for onset of migraine is between 20 and 30
years.
• Migraine affects as many as 17% of females and 6% of males in the United States.
Migraines are more common in women than men
Risk factors for migraine
• include family history, low level of education, low socioeconomic status, high
• workload, and frequent tension-type headaches.
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Categories
• The IHS subdivides migraines into categories. Migraine without aura (formerly
called common migraine) is the most common type of migraine headache.
• Migraine with aura (formerly called classic migraine) occurs in only 10% of
migraine headache episodes.
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Causes and pathophysiology
• Although many theories have addressed the cause of migraine headaches, the exact
etiology is not known. The current theory is that a complex series of neurovascular
events initiates a migraine headache.3 People who have migraines have a state of
neuronal hyper excitability in the cerebral cortex, especially in
the occipital cortex.
• Approximately 70% of those with migraine have a first degree relative who also had
migraine headaches.
• Migraine is associated with seizure disorders, ischemic stroke, asthma,
depression, anxiety, myocardial infarction, Raynaud’s syndrome, and irritable bowel
syndrome
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Cont
•
In many cases, migraine headaches have no known precipitating events.
• However, for some patients, specific factors trigger or precipitate a headache.
• These include foods, menstruation, head trauma, physical exertion, fatigue,
stress, missed meals, weather, and drugs.
• Food triggers include chocolate, cheese, oranges, tomatoes, onions,
monosodium glutamate, aspartame, and alcohol (particularly red wine)
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Cont
•
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Clinical Manifestations
SCIENCE & TECHNOLOGY
• A prodrome and an aura may precede the headache phase by several hours or
several days.
• The prodrome may include neurologic (e.g., photophobia), psychologic (e.g.,
hyperactivity, irritability), and other (e.g., food craving) manifestations.
• An aura is a complex of neurologic symptoms characterized by visual
(e.g., bright lights, scotomas [patchy blindness], visual distortions, zigzag lines),
sensory (voices or sounds that do not exist, strange smells), and/or motor (e.g.,
weakness, paralysis, feeling that limbs are moving) phenomena.
• The aura immediately precedes the headache and may last 10 to 30 minutes
before the headache starts
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Cont
• A migraine headache may last 4 to 72 hours.
• The headache is described as a steady, throbbing pain that is synchronous with
the pulse.
• Although the headache is usually unilateral, it may switch to the opposite side in
another episode.
• During the headache phase, some patients with migraine may tend to
“hibernate.” They seek shelter from noise, light, odors, people, and problems.
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CLUSTER HEADACHE
• Cluster headaches are a rare form of headache, affecting less than 0.1% of the population
• Cluster headaches involve repeated headaches that can occur for weeks to months at a time,
followed by periods of remission.
Causes and pathophysiology
• Neither the cause nor the pathophysiologic mechanism of cluster headache is fully known.
• The trigeminal nerve has a role in the production of pain, but cluster headaches also involve
dysfunction of intracranial blood vessels, the sympathetic nervous system, and pain
modulation systems.
• Imaging studies show hypothalamic activation at the onset of cluster headache.
• Alcohol is the only dietary trigger. Strong odors, weather changes, and napping are other
triggers.
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• The cluster headache is one of the most severe forms of headache, with intense
pain lasting from a few minutes to 3 hours.
• The pain of cluster headache is sharp and stabbing, which is in contrast to the
pulsing pain of the migraine headache.
• The pain is generally located around the eye, radiating to the temple, forehead,
cheek, nose, or gums. Other manifestations may include swelling around the eye,
lacrimation (tearing), facial flashing or pallor, nasal congestion, and constriction
of the
pupil.
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• During the headache, the patient is often agitated and restless, unable to sit still
or relax.
• Cluster headaches can occur every other day and as often as eight times a day.
The attacks occur in clusters. The clusters occur with regularity, usually at the
same time each day, during the same seasons of the year.
• A cluster typically lasts 2 weeks to 3 months, and then the patient goes into
remission for months to years.
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Comparison of types of headache
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OTHER TYPES OF HEADACHE
• Although tension, migraine, and cluster headaches are by far the most common
types of headaches, other types can occur.
• These headaches may be the fist symptom of a more serious illness.
• Headache can accompany subarachnoid haemorrhage; brain tumors; other
intracranial masses; vascular abnormalities; trigeminal neuralgia diseases of the
eyes, nose, and teeth; and systemic illness (e.g., bacteraemia, carbon monoxide
poisoning, mountain sickness, polycythemia vera)
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DRUG TREAMENT & TECHNOLOGY

• Acetaminophen
• NSAIDs
• Sedatives
• Muscle relaxants
• Tranquilizers
• Amitriptyline
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Nursing DIAGNOSIS & TECHNOLOGY

• Acute pain related to headache

• Ineffective self-health management related to drug therapy and lifestyle
adjustments
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Patient teaching guide
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