Reply to Case & Discussion: Headache_lisa

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In using the mnemonic “OLDCARTS”, I would also ask the patient:

  • to show me what part of her head hurts
  • how often does she get the headaches/how many times per month?
  • are they related to her menstrual cycle?
  • does she notice any correlation with foods?
  • describe the pain
  • aggravating factors?
  • related symptoms?
  • rate her headache on a scale of 1-10
  • does anyone else in the family have these headaches?

Headaches are classified as muscle contraction (tension), vascular (migraine or cluster), mixed headaches (muscle/vascular), and inflammatory. Tension headaches occur in young adults, mostly female, and have a hereditary component. They are characterized by pressure or tightness and linked with stress, anxiety, and insomnia. Migraines consist of throbbing headache, light sensitivity, nausea/vomiting, aura. Cluster headaches are intense, long-lasting, associated with nasal congestion and alcohol use. Sudden, severe headaches suggest inflammation and can be an emergency indicative of a bleed, meningitis, or CVA (Dunphy, 2015).

The practitioner can determine if it is an old or new headache by obtaining subjective data, asking about the onset and precipitating factors. This patient’s headache started after the birth of her child, possibly suggesting a hormonal link. The light sensitivity indicates that this may be a migraine. Episodic is defined as less than 14 per month and chronic is more than 15 headaches per month (Katarsarava, Buse, & Lipton, 2012). This patient has experienced an increased frequency and severity in headaches that awaken her at night, possibly indicating a brain tumor.

It is not enough to use a focused history to come to a diagnosis. A physical exam inclusive of neurological and psychological components is also necessary. In addition, a headache algorithm has been shown to be more valuable than just expert opinion (Khayamnia, Yazdchi, Heidari, & Foroughipour, 2019). Although costly, diagnostic testing is necessary to rule out medical conditions and entails chemistries, radiologic scans, and eye exams (Carey, Callaghan, Kerber, Skolarus, & Burke, 2019).

As stated above, asking pertinent questions as to the onset, location, severity, and duration of headaches can help determine which needs emergency attention.

Carey, M. R., Callaghan, B. C., Kerber, K. A., Skolarus, L. E., & Burke, J. F. (2019). Impact of early headache neuroimaging on time to malignant brain tumor diagnosis: A retrospective cohort study. PLoS ONE, 14(2), 1–12.

Dunphy, L., Winland-Brown, J., Porter, B., Thomas, D. (2015). Primary care: The art and science of advanced practice nursing. F.A. Davis Company.

Katsarava, Z., Buse, Z., & Lipton, R., (2012). Defining the differences between episodic migraine and chronic migraine.” Current Pain and Headache Reports, 16(1), 86–92. doi:10.1007/s11916-011-0233-z.

Khayamnia, M., Yazdchi, M., Heidari, A., & Foroughipour, M. (2019). Diagnosis of common headaches using hybrid expert-based systems. Journal of Medical Signals & Sensors, 9(3), 174–180.

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