List symptoms or situations in which you would refer a patient complaining of headache to his or her primary care provider.
-Severe Head Pain
-Headaches that persist for 10 days with or without treatment
-Last Trimester of pregnancy
- or = 3
alcoholic drinks per day
-Headache associated with underlying pathology
-Symptoms consistent with migraine but no formal diagnoses of migraine or headache
Tension Headache Location Nature Onset Duration Non-Headache Symptoms
- Location: Usually unilateral
- Nature: throbbing; may be preceded by an aura
- Onset: Sudden
- Duration: Hours to 2 days
- Non-headache symptoms: Nausea
Migraine Headache Location Nature Onset Duration Non-Headache Symptoms
- Location: Usually unilateral
- Nature: throbbing; may be preceded by an aura
- Onset: Sudden
- Duration: Hours to 2 days
- Non-headache symptoms: Nausea
Sinus Headache Location Nature Onset Duration Non Headache symptom
- Location: Face, Forehead, or periorbital area
- Nature: Pressure behind eyes or face; dull bilateral pain; worse in the morning
- Onset: Simultaneous with sinus symptoms including pus nasal discharge
- Duration: Days, resolves with sinus symptoms
- Non-headache symptoms: Nasal Congestion
Describe symptoms and qualities that would differentiate one condition from another.
- Tension Headache: Going to be all over the head, gradual pain, related from some form of stress or something like that.
- Migraine Headache: Migraine with or without aura, throbbing, most likely in one location
- Sinus Headache: Localized to facial areas over the sinuses and is difficult to discern from migraine without auras, usually tied to sickness
What is recommended for Tension Headache?
Acetaminophen, NSAIDS, and salicylates
What is recommended for Migraine Headache
Generally you want to give the medication at onset or before and if possible give NSAID or Salicylate
What is recommended for SinusHeadache?
Decongestants: pseudoephedrine and phenylephrine
Acetaminophen Toxicity level
*What should be daily max dose
Signs
around 4g/day (especially with alcohol)
3g ish
Signs
-Nausea, vomiting, drowsiness, confusion, and abdominal pain
-Serious problems can occur 2-4 days after, can cause liver death
NSAID Toxicity level
*What should be daily max dose
Signs
Ibuprofen = 1200 mg/ day Naproxen = 660 mg/day
These are max doses for OTC
Signs
-GI and nausea problems
-Nausea, vomiting, coma, dizziness, lightheadedness
What is recommended appropriate follow up for self-treatment of headache.
- Chronic Tension Headache: Follow up after 4-6 weeks
- Episodic Tension Headache: Follow up after 6-12 weeks
- Severe Headache: Follow up within 10 days
Determine when it is appropriate to self-treat a fever.
It is okay as long as the patient realizes these two conditions should require further medical follow-up
- Fever goes on longer for 10 days
- If pain continues to get worse with taking analgesics
Instruct a patient or caregiver on correct administration of infant acetaminophen and ibuprofen products.
- Ibuprofen: 5-10 mg/kg
- Acetaminophen 10-15mg/kg
- Aspirin 10-15 mg/kg
- Note if the patient is under a certain weight be careful about recommendations
-Acetaminophen active ingredients appropriate use dosage range effects,
- 325 mg acetaminophen per dosage unit
- every 4-6 hours
- Central inhibition of prostaglandin synthesis
- Used for reducing fever and relieving moderate to modest pain
- Max dose should be around 3000-3250 to keep accidental overdose down
Ibuprofen active ingredients appropriate use dosage range effects,
- 200-400 mg per dosage unit
- every 4-6 hours
- Inhibition of cyclooxygenase and subsequent prostaglandin sythesis
- Used for relieving pain
- Max dose is 1200 mg per day
NSAID unwanted effects of OTC oral analgesic products.
ADRs
-dyspepsia, heartburn, nausea, anorexia, and epigastric pain
Serious ADRs
- Seldom occurs, but serious heart and nausea occur\
- MI can occur (Seems to be an association)
- GI ulceration
- Can effect kidney function
- Platelet aggregation can occur
- Take with food
Aspirin active ingredients appropriate use dosage range effects,
- 650 every 4 hours or 1000 mg every 6 hours per dosage unit
- every 4-6 hours
- Inhibition prostaglandin synthesis from arachidonic acid inhibiting both isoforms of the COX enzyme
- reduces sensitivity of pain receptor
- Max dose is 4000 mg per day
Aspirin unwanted effects of OTC oral analgesic products.
- ADRs
- dyspepsia
- Serious ADRs
- Hepatic toxicity
-Teens and lower should avoid, with viral infections can cause Reye’s syndrome (doesn’t cause but it if a viral infection seems to cause something)
Acetaminophen unwanted effects of OTC oral analgesic products.
- ADRs
- Nausea, vomiting, drowsiness, confusion, and abdominal pain
- Serious ADRs
- Increased ALTS and ASTS which are signs of hepotoxicity
- Try to avoid taking with Warfarin regularly
