Sally Jones's Severe Headaches: Pertinent Subjective Findings - Research Paper

Introduction

In this case, Sally Jones reports of regularly having severe headaches at the workplace. Sally is an administrative assistant for the CEO at a local hospital in her community. Pertinent subjective findings, in this case, are as follow: she is having headaches which are generalized and bilateral in nature, pain is located at the back of her head and around her neck, severe pain resembles a constricted band around her head, lately pain has been occurring often for the past month; recently took a trip to Mexico, where she obtained some homeopathic" tea which she has been taking and Sally stated that due to the side effects of pain medications, she does not believe in treating pain with medications.

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To gather more information about Sally's chief complaint, some of the questions that should be asked include: when did the headaches start? What were you doing when the headache started? Are there any other symptoms accompanying the headache? On a scale of zero to 10, zero being no pain at all and I 0 being the worst pain ever, please rate the pain, how often does the headache occur? What relieves the headache? Have you ever had a headache like this before? Tell me about you and your family past medical history. Whether she has headaches when she is at home or any other place other than her workplace? What she has been doing recently that could be causing the frequent headaches? How long do the headaches last? Any head trauma? Are there any problems with vision during, the headaches? What medications are you taking? Any recent weight loss? Have you been hospitalized recently? Is there any pain in your eye? How long have you been at your current occupation? Finally, if it is possible that working in the hospital is the cause of the headaches?

Physical Assessment

When performing the physical examination of the patient, palpation of the head and the face, blood pressure, meningeal signs and the presence of neurological focus will be specially assessed. Hypertension is usually associated with headaches of difficult characterization (Mathew & Peterlin, 2016). However, it is important to remember that neurological conditions that increase intracranial pressure can cause reactive hypertension, so before the headache is attributed to arterial hypertension, the patient will be assessed clinically.

Diagnostic Studies

A well-detailed clinical history will be made, where the information that the patient describes her pains will be very important for the doctor. When carrying out the medical history, the form of onset, age, family and personal history, the characteristics of pain and the symptoms and accompanying diseases will be assessed. Through a semi-structured interview, the patient will be asked to describe her headache, classifying on a scale the levels according to the intensity and frequency in which it occurs. In addition, an electroencephalogram will be required to rule out any specific organic cause (Ashina, Bendtsen, Lyngberg, Lipton, Hajiyeva, & Jensen, 2015). Acute and severe headaches in patients without a previous history are especially important since they force to rule out serious diseases such as subarachnoid hemorrhage or an intracranial expansive process. The characteristics of the pain will be assessed. The type of pain is of little help in the differential diagnosis of headaches, although a throbbing pain will suggest a vascular headache. The location and irradiation data of pain, although they have no diagnostic value, can be of great clinical utility (Mathew & Peterlin, 2016). Some blood and imaging tests, such as magnetic resonance imaging, skull tomography, and electroencephalogram may be required to establish the differential diagnosis.

List of Three Differential Diagnoses for Sally's Symptoms

Sally many be suffering from migraine, cluster headache, or tension headache. The main symptom is a headache with severe pain that extends through the head, neck and facial muscles. This pain can last from 4 to 72 hours.

Most Likely Diagnosis

There are several types of headaches, each has its own characteristics. The most significant difference is the area where one feels the most pain in the head. In migraines, acute pain usually appears on one side of the front of the head, while in tension headache the discomfort is less intense and appears around the head. On the other hand, in the headache caused by cervical problems, the pain appears in the back of the skull, behind the crown (Sheeler, Garza, Vargas, & O'Neil, 2016). Cluster headache causes a severe pain that strikes the region over the eye and is felt on only one side of the head, lasts between 15 minutes and an hour, disappears, but comes back a day later.

Sally has a tension headache. Tension headache is a continuous pain around the head, with the subject feels he/she has a tight elastic band around his head. The intensity and frequency of this type of headache are variable. Symptoms often depend on the subject's stress levels, and when it occurs it usually lasts between thirty minutes to two hours. Tension headache is mainly characterized by a picture of tension in specific areas of the body that triggers the headache (Waldie, Buckley, Bull, & Poulton, 2015). The areas of the body where the pressure generates this type of headache are as follows: scalp, head, face, neck, and shoulders. When the muscles in these areas contract due to tension, tension headache is generated. The prevalence of this condition occurs mostly in adults, especially women.

States of stress, anxiety, depression, or trauma at the level of the skull are the most commonly recorded causes of tension headaches. Over time, certain specific jobs can cause tension headache in people, especially those jobs that require a person to remain in front of a computer for a long time (Ashina et al., 2015). The neck position directly influences the headaches, maintaining an atypical position while sitting or while sleeping will cause our neck to be loaded with muscle tension, which will inevitably trigger the headache.

Treatment Plan (Pharmacological and Non-Pharmacologic Therapies)

The treatment of headaches can take several forms, pharmacological or non-pharmacological. Drugs are an important part of treatment, especially when an acute attack occurs. But medication is much more effective when its use is accompanied by a joint plan of change in some lifestyle habits and modification of precipitating factors. There are currently multiple alternative treatments, non-pharmacological, that psychologists and other specialists can provide (Sheeler et al., 2016). Once the diagnosis is made, the best treatment to control or eliminate headaches is determined. In the case of Sally, cognitive behavioral therapy will be used to identify and modify the negative thoughts that generate stress and anxiety. The pharmacological treatment when the pain crisis occurs will consist of beta-blockers, antidepressants and anti-inflammatory analgesics in the acute phase of the ailment. These medications should not be taken for more than two days a week, as doing so can cause chronic pain. Non-pharmacological treatments to be used will be biofeedback, reflex responses, operant behavior, acupressure, acupuncture, while the therapies to be used include:

Psychological Therapy

If the headache is due to hard work, stress, depression, and anxiety, psychological counseling may be a good alternative for learning to cope with feelings and routine.

Food Therapies

The diet has an important relationship with having headaches and migraines. Thus, for example, fasting is one of the main reasons for migraine, so one should avoid prolonging time without eating and maintaining a regular meal schedule. There are food components that also favor the non-occurrence of tension-type headaches, they include (Waldie et al., 2015): vitamins (Especially riboflavin (B2), which is recommended to consume 400 milligrams daily). Magnesium: A daily intake of a minimum of 500 milligrams is recommended. Botanical preparations: Inhalation of vapors, massages with lavender or anise, eucalyptus or peppermint baths, the application of peppermint or ginger compresses or infusions.

Physical Therapies

Some of the physical therapies recommended for Sally include acupuncture, massages, body treatments, Qigong, chiropractic medicine, yoga, and osteopathic medicine.

Mental Therapies

Some of the mental therapies recommended for Sally include electric feedback. Electric feedback therapy monitors body sensations, from temperature to muscle tension.

Relaxation techniques are another alternative to reduce pain, as well as avoiding stress. Other options that do not involve taking drugs include trying to follow healthy lifestyle habits and keeping a regular sleep schedule.

Difference In Pharmacologic Intervention in Acute Versus Chronic Presentation

Chronic or recurrent headaches are usually vascular (migraine) or psychogenic. Regarding the age of onset of headaches, young patients (10-30 years) usually present with headaches of vascular origin, while those that occur in individuals older than 60 years force to rule out other processes, such as temporal arteritis, a cerebral proliferation, or even a vascular headache (Linde et al., 2016). Classically, it is pointed out that women have a greater predisposition to present common migraines, while men suffer more frequently from accumulated headaches of Horton. The existence of a family history of recurrent headache will lead to a classic or common migraine since these are found in 70% of patients suffering from this disease.

References

Ashina, S., Bendtsen, L., Lyngberg, A. C., Lipton, R. B., Hajiyeva, N., & Jensen, R. (2015). Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia, 35(3), 211-219. https://doi.org/10.1177/0333102414535110

Linde, K., Allais, G., Brinkhaus, B., Fei, Y., Mehring, M., Shin, B. C., & White, A. R. (2016). Acupuncture for the prevention of tensiontype headache. Cochrane Database of Systematic Reviews, 19 (4), 1-57. https://doi.org/10.1002/14651858.CD007587.pub2

Mathew, P., & Peterlin, B. L. (2016). Tension-type headache. In Clinician's Guide to Chronic Headache and Facial Pain (pp. 30-44). CRC Press.

Sheeler, R. D., Garza, I., Vargas, B. B., & O'Neil, A. E. (2016). Chronic daily headache: ten steps for primary care providers to regain control. Headache: The Journal of Head and Face Pain, 56(10), 1675-1684. https://doi.org/10.1111/head.12881

Waldie, K., Buckley, J., Bull, P. N., & Poulton, R. (2015). Tension-type headache: A life-course review. University of Auckland Research Repository, ResearchSpace. Retrieved from https://researchspace.auckland.ac.nz/bitstream/handle/2292/28487/Waldie%20Buckley-tensiontype-headache-a-lifecourse-review-2015.pdf?sequence=6