Discuss the different types of headaches, the possible causes of each, and how to distinguish a harmless headache from a potentially life-threatening condition. (pp 676–678)

A. One of the most common complaints you will hear from your patients in terms of pain is headache.

1. Headache can be a symptom of another condition or it can be a neurologic condition on its own.

2. Only a small percentage of headaches are caused by a serious medical condition.

3. Most headaches are harmless and do not require emergency medical care.

4. Sudden, severe headache, however, requires assessment and transport.

a. If more than one patient reports headache, consider carbon monoxide poisoning.

B. Tension headaches, migraines, and sinus headaches are the most common types.

1. These are not medical emergencies.

2. Tension headaches are the most common.

a. These headaches are caused by muscle contractions in the head and neck and are attributed to stress.

b. The pain is usually described as squeezing, dull, or as an ache.

C. Migraine headaches are the second most common type of headache.

1. They are thought to be caused by changes in the blood vessel size in the base of the brain.

2. The pain is usually described as pounding, throbbing, and pulsating.

3. Migraines are often associated with visual changes such as flashing lights or partial vision loss.

4. The patient will often have nausea and vomiting.

5. Migraine headaches can last for several days.

D. Sinus headaches are caused by pressure that is the result of fluid accumulation in the sinus cavities.

1. Patients may also have coldlike signs and symptoms of nasal congestion, cough, and fever.

2. Prehospital emergency care is not required.

E. Serious conditions that include headache as a symptom are hemorrhagic stroke, brain tumors, and

meningitis.

1. You should be concerned if the patient complains of a sudden-onset, severe headache or a sudden

headache that has associated symptoms.

2. You should suspect a stroke in patients with a severe headache, seizures, and AMS.

3. Your patient assessment should include asking the patient if he or she has experienced any recent  head trauma.

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