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The headache is the pain felt in the face, forehead, eyes, jaws, temples, skull, or neck. According to Oyama (2019), headache has four classifications, namely migraine, tension, cluster, and other primary headaches. As mentioned, there are primary headaches type that is chronic. In contrast, the secondary headache is usually the worst headache that has no relief and with accompanying symptoms like weakness of the extremities or may be caused by an injury that may lead to a hematoma, hemorrhage, meningitis, stroke, brain abscess, and other severe or life-threatening conditions.

According to Yi-Ting Wei, Ong, and Goadsby (2018), the pathophysiology of headache includes activation of trigeminovascular complex and trigeminal-autonomic reflex for the severe unilateral headache. The migraine headache is a rapid onset, unilateral, throbbing, associated with nausea and vomiting, or even with transient neurological deficits such as numbness and tingling. The patients with migraines are debilitated and unable to perform daily activities. On the other hand, cluster headaches are lasting from 15 minutes to 180 minutes up to 8 times a day. The pain is characterized by unilateral pain in the trigeminal nerve with prominent unilateral cranial autonomic symptoms and a sense of agitation on the attacks.

The episodic headache is the attack that is strictly unilateral and may alternate the bouts but not on the attack itself. It is cyclical that it happens at the same time of the year and at the same time of the day. The pain involves ptosis, conjunctival injection, lacrimation, rhinorrhea, decongestion, facial sweating, and flushes. Ninety percent of the patients afflicted with episodic headache experience the attack from 7 days to a year, which is averaging from 2 weeks to 3 months.

The acute headache is localized in any part of the head, behind the ears, eyes, and in the neck. Usually, it is a benign diagnosis, but it is a high index for suspicion for the fatal effect of headaches. The headache may be a primary or benign, which include tension, migraine, cluster, sinus, and environmental induced headache. On the other hand, the secondary can be life-threatening headaches caused by trauma, hemorrhagic stroke, brain cancers, or encephalitis (Yi-Ting Wei, Ong, & Goadsby, 2018).

The chronic tension headache is short in the duration of an attack, like 30 minutes to a week. The frequency occurs not more than 15 days in a month for the three months. These incidences or episodes may become chronic (Mayo Clinic, 2019). The tension headaches are long and continuous. This headache is felt 15 days, or more is considered chronic. The cause may be hormonal and related. The triggers of migraines include chocolates, wines, not enough sleep, coffee, caffeine, sweeteners, and processed food like cheese.

According to Savoy (2020), the evidence-based treatment plan for management is the OnabotulinumtoxinA minimizes the episodes of migraine days by two in a month as compared to the placebo for chronic migraines. There are adverse effects on the patients given with onabotulinumtoxinA as to the number needed to harm (NNH) is 7; 95% CI, 4 to 17 than the adverse effects total that is NNH is 7; 95% CI, 6 to 9.

The patient education or teaching regarding headaches includes encouragement of diary of headaches and identification of triggers. Teach the patient who has menstrual headaches to prevent precipitating factors such as alcohol, tyramine, missed meals and sleeping late. Besides, muscular headaches are non-menstrual, biofeedback, breathing exercises, visualizations are helpful, and develop lifestyle changes and exercises. Treatments and management involve medications such as acetaminophen, verapamil, oxygen therapy, ibuprofen, ergot derivatives, and muscle relaxants (Savoy, 2020).

In conclusion, the prevalence of migraine headaches is higher among women, while cluster headache is more prevalent among males. Incidence is common in the age of younger than sixty-five years. The headache may be a discomfort that affects the quality of life, and so the APRN intervenes with treatment and management with healthy habits, relief of practical nonpharmacological approach, and utilizing the right medications (Oyama, 2019).

References:

Yi-Ting Wei, Ong, & Goadsby. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 5, 3. https://doi.org/10.4103/aian.AIAN_349_17

Mayo Clinic (2019). Tension headache. Retrieved from https://www.mayoclinic.org/diseases-conditions/ten…

Mingels, S., Dankaerts, W., & Granitzer, M. (2019). Is There Support for the Paradigm “Spinal Posture as a Trigger for Episodic Headache”? A Comprehensive Review. Current Pain And Headache Reports, 23(3), 17. https://doi.org/10.1007/s11916-019-0756-2

Oyama, O., Ph.D. (2019). Headaches. Magill’s Medical Guide (Online Edition).

Retrieved from https://www.medscape.org/viewarticle/808288_transcript

Savoy, M. (2020). OnabotulinumtoxinA for the Prevention of Chronic Migraine in Adults. Retrieved from https://www.aafp.org/afp/2020/0201/p144.html

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