Different types of headaches

Different types of headaches
Additional questions
I would use the popular acronym OPQRST to ask about the patient’s headaches and find out more about them. I would ask her when the headaches started, which was two years ago after she had a baby. I would ask her what makes the headaches worse and what makes them go away so I could make a correct evaluation. This could be your body situation, what you’re doing, or something like light. I would ask her how her headaches feel, like if they are sharp, dull, pulsing, beating, “pins and needles,” “pressure,” or throbbing.

I would also ask where the headache is, if it is on one side or both sides, to get rid of some possible explanations and focus on the right one.I would also ask if it is spreading to other areas and what the signs are. In this person’s case, the related signs would be times when they throw up when they have a headache. I would ask how bad the headache is on a range from 0 to 5, where 0 means no pain and 5 means the headache is very bad. Lastly, I’d ask the person how their headaches have changed over time. I would also want to know if the headaches are worse at certain times of the day. I would ask the patient how many times she had headaches in 30 days.

Different types of headaches

Most headaches can be put into two groups: primary headaches and secondary headaches. Primary headaches are not dangerous and happen often. 90% of all headaches are caused by them. (Purdy-Payne, 2018). Most people who have them are between 20 and 40 years old. They aren’t caused by any underlying health problems or structural problems. The most common of these are migraines and tension-type headaches. Migraines show up in the body as a pulsing or aching headache, nausea or vomiting, and a visual disturbance called an aura. (Purdy-Payne, 2018). Tension headaches cause “band-like” pain on both sides of the head that doesn’t move. Most of the time, it doesn’t come with other symptoms like headaches do.

On the other hand, about 10% of headaches are caused by something else. Purdy-Payne (2018) says that they are more dangerous and are caused by something else, like illnesses like meningitis, head injuries, vascular problems, bleeding inside the brain, or tumors. (Purdy-Payne, 2018). When the cause of the headache is fixed or treated, the headache symptoms get a lot better.

figuring out if it’s a long-term or short-term problem

Most of the time, an episodic or acute condition comes on quickly, with symptoms that come on quickly and don’t last long. When treated correctly, the signs of acute conditions usually go away within six months. (Diamond et al., 2015). On the other hand, a chronic disease comes on slowly, with symptoms that start out mild and get worse over time. Diamond et al. (2015) say that even with care, the symptoms of chronic conditions tend to last longer than six months.

Based on what you said, I would say that this patient’s headache is one that lasts for a long time. She’s been having the headache for two years. Even though she took Tylenol for it, the pain got worse and happened more often over the past six months, so she had to get more medicine.

History with both open-ended and targeted questions

First, I would get the patient’s medical background and find out if anyone in the family has ever had migraines. Steiner et al. (2015) say that between 70 and 90% of people with migraines have a history of migraines in their family. Migraines can also be caused by changes in hormones. Using the acronym SOCRATES, I would find out about the patient’s past and ask focused questions to make a clear evaluation. S stands for site. I would ask the patient to tell me where her headache is and show me with her finger. Migraines show up in the clinic as one headache, while stress headaches show up as two headaches. (Purdy- Payne, 2018). O is for beginning. I’d find out when the headaches began, which was two years ago. Based on the patient’s past, the symptoms came on slowly. Migraines cause headaches that last from four hours to three days and happen often. It can take a few months or even a few years. (Purdy- Payne, 2018).

The letter C is for character. In this part, I would ask what the headache was like and how it felt. For example, stress headaches cause tightness and pressure around the head. (Purdy- Payne, 2018). Cluster headaches are marked by pain that is sharp or stabbing, while migraines are marked by pain that pulses or throbs. (Purdy- Payne, 2018). Radiating is what R stands for. To figure out the prognosis, I would ask if the headache spreads to any other area. Purdy-Payne (2018) says that pain that spreads from a headache is often a sign of a second headache. Meningitis is linked to pain that goes to the neck, while trigeminal neuralgia is linked to pain that goes to the face. Acute closed-angle glaucoma is linked to pain that spreads to the eye.

A stands for signs that go with it. I would ask the person if they have any other signs besides headaches. In this case, headaches are sometimes accompanied by nausea and a fear of light. The letter T means “time course.” I would ask the person how the headache has changed in the past two years. It seems to have gotten worse over the past six months. When headaches get worse in the morning, it could be because of an increase in cerebral pressure, which could be caused by a space-occupying lesion. (Purdy- Payne, 2018).

E stands for factors that make things worse or make them better. I would ask the person if there is anything or anything that makes the pain start or get worse. Position, coughing, mental stress, and caffeine can all be causes. (Diamond et al., 2015). Changes in body position and getting enough water can help ease the pain. (Diamond et al., 2015). In this case, the patient’s headache goes away when he or she stays in the dark. S is for “severe.” I would figure out how bad the headache was by asking the person how bad the pain was on a scale from 0 to 10, where 0 means no pain and 10 means very bad pain. I would ask the patient how her headaches have changed the way she goes about her daily life. Based on this background, I would say that the possible diagnoses are either migraine or tension headache that has gotten worse and more frequent in the past six months, which is a red flag.

Using a patient’s past to tell the difference between mild and severe headaches

Based on the patient’s background, at first glance, this seems to be an old headache. Most old headaches are primary headaches, which aren’t dangerous. ICHD (2019) says that aura is a type of headache, and when it happens with a migraine, the patient has a dangerous headache. The guidelines say that the sensory symptoms, like seeing flickering lights or spots, losing your sight, or having your hearing or sense of smell change, can be helped by the right medicines. On the other hand, new headaches often have the red flags listed in the ICHD (2019) standards. This is a strong sign that the headache is secondary. In this patient’s case, the headaches have been getting worse and happening more often over the past six months. Even though she had been taking Tylenol for a long time. So, this is a real pain in the head.

Diagnostic tests

I would recommend that the patient get a brain scan and a drug test to find out more. This is because the headaches have been getting worse and more frequent, even though the patient has been taking Tylenol every day. This kind of headache could be caused by a brain mass, a subdural hematoma, or taking too many medicines. The idea behind these possible causes is that the brain mass or subdural hematoma gets bigger over time, putting more pressure on the tissues around it and making the pain worse. The ICHD (2019) standards also say that the more headache medicine a person takes, the worse and more often their headaches get. As soon as the diagnosis was confirmed, I would send this patient to a neurology nurse practitioner for further care. A neurology nurse’s job is to assess, treat, manage, and write prescriptions for people who are getting neurological procedures done.

A flow chart for differential testing

Differential diagnosis

Diagnostic tests

Migraine

Neuroimaging, drug screen

Headaches from stress

X-rays of the sinuses and tests in the lab to look for other problems.

References

Diamond, S., Cady, R. K., Diamond, M. L., Green, M. W., & Martin, V. T. (Eds.). (2015). Headache and migraine biology and management. Academic Press.

International Classification of Headache Disorders. (2019). Migraine. Retrieved from https://ichd-3.org/1-migraine/

Purdy-Payne, E. K. (2018). Understanding headaches classification. headache, 1, 2.

Steiner, T. J., Birbeck, G. L., Jensen, R. H., Katsarava, Z., Stovner, L. J., & Martelletti, P. (2015). Headache disorders are third cause of disability worldwide.

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