1. Engagement in Meaningful Dialogue: Respond to a student peer and course faculty to further dialogue.
a. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources).
b. Student responds to at least one peer.
c. Student responds to all direct questions posed by faculty.
d. Post includes evidence from at least one scholarly resource to support interactive dialogue.
2. Professionalism in Communication: Present information in a logical, meaningful, and understandable sequence that is relevant to the discussion topic.
a. Grammar, spelling, and/or punctuation are accurate.
b. Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 10 words). The quote must add substantively to the discussion.
REPLY POST NEEDED FOR THE FOLLOWING POST:
Migraine headaches and tension headaches, also commonly referred to as tension-type headaches (TTHs), account for greater than 90% of the 3 billion incidents of individuals suffering from headaches throughout the world. While tension headaches are more common, individuals with migraine headaches are seen more often in the healthcare setting due to their debilitating nature. Migraine headaches and tension-type headaches are considered primary headaches with no specific underlying cause attributing to their primary diagnosis (McNeil, 2021).
Presentation:
Both migraine headaches and tension-type headaches are more common in Caucasian women than men, often occur earlier in life and are less common after the age of 50 (Buttaro et al, 2021). Patients presenting with migraine headaches may complain of an aura, such as a visual, sensory, speech or motor disturbance, that often occurs prior to the onset of symptoms. Patients most commonly experience the onset of symptoms gradually over the course of 1-2 hours with symptoms persisting over a period of 30 minutes to 7 days. Additionally, migraines are often accompanied with nausea, vomiting, sensitivity to light (photophobia), and sound (phonophobia), while these symptoms are not common in tension-type headaches. Further, in contrast to migraines, tension-type headaches are not commonly accompanied with complaints of an aura and often have a gradual onset. Patients presenting with tension-type headaches may experience symptoms from 4 to 72 hours. They often awake with the discomfort, experience the symptoms throughout the entire day, or intermittently, and notice the symptoms when attempting to go to sleep. Patients with migraine headaches may describe the pain as pulsating, throbbing, or a sensation of pressure/tightness that is moderate to severe in nature. Additionally, patients commonly complain of bilateral pain that is typically located in the frontotemporal region. In contrast, the pain associated with tension-type headaches is commonly mild to moderate, can be unilateral or bilateral and described as dull throbbing pressure around the head. Patients with tension-type headaches are often able to function throughout the day and complete daily tasks, while patients with migraines are restless, irritable, ill-appearing and find it difficult to function due to the severity of symptoms (McNeil, 2021).
Risk factors associated with migraine headaches include a strong family history of migraines, females experiencing their menses and/or hormonal changes, increased stress, exposure to strong odors, ineffective sleep patterns, vasodilators, etc. Tension-type headaches have similar risk factors as migraine headaches, such as stress, ineffective sleep patterns and hormonal changes. However, in contrast to migraine headaches, additional risk factors for tension-type headaches include anxiety, depression, jaw clenching and/or teeth grinding, medications such as nitrates, antihypertensives, SSRIs, poor posture with associated muscle tenderness and/or stiffness, etc. (Buttaro et al, 2021).
Pathophysiology:
In addition to the genetic inheritance risk factor that impacts the nervous system, migraines are caused by complex neuronal irregularities that ultimately effect the trigeminovascular system. This results in inflammation within the pain receptors of the meninges. In short, this inflammation causes the pain associated with migraine headaches. In contrast, studies do not support a genetic predisposition for tension-type headaches. Further, tension-type headaches are the result of pain receptors that are triggered within the pericranial myofascial tissue. This prolonged muscle tension can result in chronic tension-type headaches (McNeil, 2021).
Assessment:
When assessing patients that present with complaints of a headache, it is important to perform a thorough neurological exam. This includes examining the patient’s pupils, extraocular movements and identifying any evidence of asymmetry that could indicate an emergent underlying cause. It is equally important to evaluate the patient’s extremities for weakness and/or deficits, their posture and neck ROM. Additionally, in order to properly diagnose the patient, palpating the patient’s shoulder and neck muscles for tenderness and/or stiffness is necessary, as well as assessing their sensitivity to light and/or noise. Further pertinent physical assessments include vital sign readings, such as the patient’s blood pressure, heart rate, temperature, etc., and thoroughly examining the patient’s temporomandibular joint for any clicking and/or tenderness (Buttaro et al, 2021).
Diagnostic testing is dependent upon the patient’s physical assessment. Diagnostic testing is only warranted if the patient is found to have exam findings that are considered red flags. This includes patients that present with severe headaches and are 50 years or older, new onset severe headaches, abnormal neurological exam, etc. In these situations, diagnostic tests to consider include imaging, labs, urinalysis, EEG, etc. (Buttaro et al, 2021).
Diagnosis:
A valuable screening tool used to diagnose headaches is well known as the mnemonic POUND. The P refers to the pulsatile quality, the O refers to the duration of the headache, the U refers to the headache as being unilateral in nature, the N refers to the presence of nausea/vomiting and the D refers to the intensity that can be disabling in nature. As discussed throughout this discussion, there are many similarities between migraine and tension-type headaches. However, there are definitive characteristics of each that can guide the clinician towards the correct diagnoses. If the patient experiences an aura, nausea, vomiting, photophobia, photophonia, bilateral moderate to severe pulsating pain and inability to remain active due to the severity of symptoms, etc., this would indicate a diagnosis of a migraine. If the patient complains of dull throbbing, mild to moderate pain that is associated with percranial tenderness, muscle tightness or stiffness in the neck or shoulders, ability to function and conduct simply tasks, this would indicate a diagnosis of tension-type headache. Furthermore, additional differential diagnoses to consider include sinusitis, temporomandibular joint dysfunction, trigeminal neuralgia, or emergent secondary headaches as a result of intracranial abnormalities, meningitis, etc. (McNeil, 2021).
Management:
Acute migraine headaches and tension-type headaches can be can be treated with OTC NSAIDs and acetaminophen. Additionally, educating the patient on the avoidance of triggers, cognitive behavioral therapy, relaxation training, quiet atmosphere, adequate sleep, healthy diet choices, etc. are all preventative measures the patient can take to avoid flares. Preventative and/or abortive medications for more frequent migraines includes triptans, ergotamines, ditans, beta blockers, calcitoningene related peptide antagonists, anticonvulsants, antiemetics, etc. Each treatment plan is individualized based on the patient’s clinical presentation and severity of symptoms. In contrast, tension-type headaches may be treated with antidepressants, anticonvulants, muscle relaxants, etc. (McNeil, 2021).
References
Buttaro, T. M., PolgarBailey, P., SandbergCook, J., & Trybulski, J. (2021). Primary care: A collaborative practice (6th ed.). Elsevier Health Sciences (US).
McNeil, M. (2021). Headaches in adults in primary care: Evaluation, diagnosis, and treatment. Medical Clinics, 105(1), 39-53. https://doi.org/10.1016/j.mcna.2020.09.005
PLACE THIS ORDER OR A SIMILAR ORDER WITH RESEARCH MOLE TODAY AND GET AN AMAZING DISCOUNT
