Headaches are the most commonly experienced discomfort in the world, though, are not entirely understood by professionals across all professions. As frontline healthcare professionals, headaches may be frequently encountered and cause patients throbbing discomfort. Paramedics, nurses, and other medical professionals need to understand the perplexing puzzle that headaches are, considering this, this article will delve into what is suspected in pathophysiology, signs and symptoms and a plethora of treatment options.
Pathophysiology
Though the complete pathophysiology of headaches is not completely understood, it’ll be investigated in this section the theories behind what is believed to be the cause of different types of headaches. The most prevalent headache is the tension-type headache; the theory behind the cause of this headache is that it is associated with stress, tension in the muscles of the head and neck, and anxiety. Overall, the pathophysiology of tension-type headache is a result of hypersensitivity of trigeminal afferent fibres caused by increased tension in the neck and cranial muscles. This tension can result from stress, excessive muscle contraction, bright lights, and inconsistent sleeping patterns. Migraines are also a common type of headache, these headaches can be divided into two separate subtypes, migraine with aura and migraine without aura. Migraines with aura make up to 30% of all migraines; aura refers to specific neurological symptoms that can be experienced over 20-60minutes, these include: visual disturbances (flashing lights, zigzags, shimmering lights), tingling in the face or other body parts, temporary problems understand language and weakness in certain body parts. Migraine without aura, the most common migraine subtype (70%), is a severe pulsating pain in the head, often localised to a single side of the head. The pain of this migraine may be accompanied by nausea, vomiting, phonophobia (sensitivity to sound), and photophobia (sensitivity to light). The most common theory behind migraines is the neurovascular theory. This theory suggests that the trigeminal nerve releases neuropeptides, leading to vasodilation and inflammation around the meninges. The final headache that’ll be focused on is the cluster headache, the cluster headache is one of the more painful headaches and is localised pain in or around one of a patient’s eyes. Just like the other headaches discussed, cluster headache pathophysiology is not entirely understood, two contributors believed to be involved are the trigeminal autonomic reflex and hypothalamic involvement. During a cluster headache the trigeminal nerve is believed to be activated, this activation results in calcitonin gene-related peptides and substance P releasing, triggering vasodilation of the blood vessels in the head and face. These occurrences result in the symptoms typically seen in a cluster headache. Hypothalamus is a region deep within the brain which regulates the body’s circadian rhythms and sense evidence suggests cluster headaches occur at the same time day or night, it is alleged that there are abnormalities or dysfunctions in the hypothalamus. In conclusion, it is evident that a great extent of further investigations and study is required to completely understand the working behind headaches but given the knowledge of the working of the brain, it can be assumed that some of the underlying stressors are resulting in patients suffering from this pain.
Clinical manifestations/ signs and symptoms
Through reconnaissance into the clinical manifestations of the patient’s complaint, clinicians can diagnose the correct type of headache and treat and transport the patient accordingly.
Tension-type headache
- Mild to moderate pain, non-throbbing
Migraine
- Recurrent and severe pain (can be throbbing/pulsating and unilateral)
- Nausea
- Photophobia
- Phonophobia
- Weakness and fatigue
Migraine with aura (migraine symptoms with added aura symptoms)
- Visual disturbances (flashing lights, blind spots, shimmering lights, and zigzag lines)
- Tingling in the face and other body parts
- Language and speech difficulties
Cluster headaches
- Severe/intense unilateral pain (often centred around the eye and are regular attacks)
- Lacrimation (watery eyes)
- Nasal congestion
- Redness and swelling of the eye
- Restlessness
- Photophobia and phonophobia
Treatment
The most common treatment for headaches involved fluids and pain management medications. The medication more commonly administrated is ibuprofen, though if the headache is severe, a stronger opioid may be required based on the patient's pain assessment. Consider transportation and offer fluids to keep the patient hydrated, especially if dehydration is an associated factor contributing to their headache. Overall, treating the patient through pain management will relieve the patient of much distress, furthermore, transportation would be advised to find the underlying cause of the pain and have the patient placed into the care of a physician who can place them on the right path of care.
In conclusion, understanding the pathophysiology, signs and symptoms of headaches are of paramount importance for all clinicians in providing comprehensive and effective care to patients suffering from a painful and uncomfortable condition. Moreover, headaches must be treating patient to patient, as the condition varies in symptoms and severity, the headache can just be a tension-type headache that will subside or the pain could be resulted from a migraine with aura, a condition that the patient will need continuous treatment and assistance for. As emergency clinicians, it is vital to understand the workings of headaches and ways to provide relief for patients.
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