Headache is the most common neurologic symptom. It has been estimated that more than 35 million individuals in the United States suffer from recurrent headaches. Most of these patients have headaches that are related to migraine, muscle contraction, or tension. A headache pattern that is unchanged and has been present for several years is unlikely to be related to present illness of the patient. Several points must be clarified for any patient complaining of a recent change in the frequency or severity of headaches. Ask the following questions:
''How long have you been having headaches?''
''When did you notice a change in the pattern or severity of your headaches?'' ''How has the pattern of your headaches changed?'' How often do your headaches occur?'' How long does each headache last?'' ''Which part of your head aches?'' ''What does the headache feel like?'' ''How quickly does the headache reach its maximum?''
When you get headaches, do you have any other symptoms?'' ''Are you aware of anything that produces the headaches?'' ''Are there any warning signs?'' ''Does anything make the headaches worse?'' What makes the headaches better?''
Patients complaining of a sudden onset of headache usually have more serious illnesses than patients with headaches of chronic duration. A continuous headache can be related to muscle spasm, whereas a recurrent headache may be a migraine or cluster headache. A throbbing headache often has a vascular cause. Certain headaches are associated with visual phenomena, nausea, or vomiting. In patients with increased intracranial pressure, any maneuver that increases the pressure, such as coughing or bending, may worsen the headache. In any patient who experiences a severe, sudden headache, stroke should be suspected.
Migraine is a biphasic type of headache associated with a prodromal phase, called the aura, followed by the headache phase. During the aura, one or more physiologic events may occur. These include transient experiences of autonomic, visual, motor, or sensory phenomena. Common visual symptoms are photophobia, blurred vision, and scotomata. As the aura fades, the headache begins. It is usually unilateral and is often described as pulsating; it can last for hours to days. Migraine headaches are often triggered by stress, anxiety, the use of birth control pills, and hormonal changes. Many patients experience migraine headaches after a period of excitement. Other important triggers are hunger and the ingestion of certain foods such as chocolate, cheese, cured meats, and highly spiced foods. There is often a family history of migraine.
Cluster headaches are associated with oculosympathetic disturbances. The typical patient is a middle-aged man complaining of recurrent episodes of pain around the eye that last for up to 1 hour. Classically, cluster headaches awaken the patient from sleep on successive nights for 2 to 4 weeks. There is ipsilateral miosis, ptosis, conjunctival edema, tearing, and nasal stuffiness during the headache. It is thought that alcohol may precipitate such attacks.
Headache may be the result of referred pain from sinus infections, ocular disease, or dental disease. Systemic conditions such as viral infections, chronic obstructive pulmonary disease, and poisoning may produce headaches. Determine whether the patient is taking any medications that may be producing the head pain. (See Table 21-2, which provides an approach to patients with the symptom of headache.)
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Headache Happiness! Stop Your Headache BEFORE IT STARTS. How To Get Rid Of Your Headache BEFORE It Starts! The pain can be AGONIZING Headaches can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows. And just think of how unwelcome headaches are while you're trying to work.