Lecture 4: Headache, Fever and Pain II

Question 1

Primary headache

Answer 1

• Not associated w an underlying illness

- Migraine, Sinus and Tension-Type headache

Question 2

Migraine

Answer 2

• Complex interaction of neuronal and vascular factors
• Dysfunction of the trigeminovascular system
• Sudden throbbing/ pulsating pain
• Lasts hours to 3 days

Question 3

Sinus

Answer 3

Infection or blockage of the paranasal sinuses

• Dull bilateral pain, pressure behind eyes/ face
• with sinus symptoms
• Last days

Question 4

Tension-Type headache

Answer 4

• Underlying cause uncertain
• Episodic vs chronic
• Gradual pain
• Headache, neck pain, tight pressure
• Lasts minutes to days

Question 5

Headache: Exclusions to Self Care

Answer 5

§ Severe head pain
§ Rapid onset of maximum pain
§ Concerning change in headache pattern
§ First or worst headache
§ Gradual escalation over months
§ Headache that persists for 10 days (+/- treatment)
§ High fever/signs of infection, neck stiffness, neurologic changes
§ Last trimester of pregnancy
§ New headache during pregnancy
§ Age <8 years
§ History of liver disease or consumption of ≥3 alcoholic drinks/day
§ Secondary headache (except for minor sinus headache)
§ Migraine without formal diagnosis

Question 6

Tension Type Headaches: Non Pharmacologic Therapy

Answer 6

• Physical Therapy

- Relaxation exercises

Question 7

Migraine Headache: Non Pharmacologic Therapy

Answer 7

• Ice packs combined with pressure
• Regular eating, exercise and sleeping schedules
• Stress management

Question 8

Sinus Headache: Pharmacologic Therapy

Answer 8

• Acetaminophen, NSAIDS, Aspirin

- Nonprescription analgesics combined with decongestants

Question 9

Migraine Headache: Pharmacologic therapy

Answer 9

• Medical diagnosis required prior to self care
• NSAIDS, Aspirin
• Nonprescription analgesics taken at headache onset

Question 10

Episodic Tension Headache: Pharmacologic Therapy

Answer 10

• Acetaminophen, NSAIDS, aspirin

- Nonprescription analgesics taken at headache onset

Question 11

Fever

Answer 11

• Regulated rise in body temperature in response to a pyrogen
• Most are self-limiting and nonthreatening
• Temperature greater than 100 F
• Caused by response to medication, vigorous activity, infection and pathology

Question 12

Fever: Exclusions to Self-Care

Answer 12

> 3 mths w rectal temp > or equal too 104 F

• < 3 mths w rectal temp > or equal to 100.4 F
• Older than 2 yrs w fever that last longer than 3 days
• Younger than 2 yrs old w fever that last longer than 24 hours
• Children who develop spots or rash, refuse to drink fluids or are vomiting and cannot keep down fluids, are very sleepy/ hard to wake, repeated diarrhea, history of seizures, stiff neck
• Fever that repeatedly rises above 104 oF (40 oC)
• Severe symptoms of infection that are not self-limiting
• Risk for hyperthermia
• Impaired oxygen utilization
• Impaired immune function
• Central nervous system (CNS) damage

Question 13

Goals of Self-treatment

Answer 13

• Alleviate discomfort
  Adequate hydration
  Non-Pharm- Children increase intake by 30-60mL per hour
  -Adult increase intake by 60-120mL per hour
• removing clothes and light blanket

Pharm- Nonprescription antipyretics
§ Acetaminophen, NSAIDs, aspirin

Question 14

Musculoskeletal Pain

Answer 14

• Pain in bones, connective tissues, joints and muscles

Complaints result in increased use of health care system, lost
work days, other limitations, and loss of employment

Question 15

Musculoskeletal Pain: Exclusions to Self Care

Answer 15

§ Severe pain (pain score >6)
§ Pain that lasts >10 days
§ Pain that continues >7 days after treatment with a topical analgesic
§ Increased intensity or change in character of pain
§ Pelvic or abdominal pain (other than dysmenorrhea)
§ Accompanying nausea, vomiting, fever, or other signs of systemic
infection or disorder
§ Visually deformed joint, abnormal movement, weakness in any limb,
numbness, or suspected fracture
§ Pregnancy
§ <2 years of age
§ Back pain and loss of bowel and/or bladder control

Question 16

Musculoskeletal Pain: Non Pharmacologic Therapy

Answer 16

§Prevention
§ Adequate hydration, appropriate footwear, stretching/warming up

- RICE therapy
Rest area until pain reduced
Ice for 15-20 mins 3-4 times/day
Compression with elastic support
Elevate for 2-3 hours

• Heat therapy apply for 15-20 mins, 3-4 times per day
• Proper posture and ergonic controls

Question 17

Musculoskeletal Pain: Goals of Self treatment

Answer 17

1. Decrease subjective intensity/severity of pain
2. Decrease duration of pain
3. Restore function of affected area
4. Prevent re-injury and disability
5. Prevent acute pain from becoming chronic persistent pain

Question 18

Secondary Headache

Answer 18

§ Symptoms of an underlying condition

Question 19

Migraine Symptoms

Answer 19

Headache, Nausea

Question 20

Migraine Characteristics

Answer 20

Throbbing/pulsating,
may be preceded by
aura

Question 21

Migraine Onset

Answer 21

Sudden

Question 22

Migraine Location

Answer 22

Usually unilateral

Question 23

Migraine Duration

Answer 23

Hours to three days

Question 24

Sinus Symptoms

Answer 24

Headache,

nasal congestion

Question 25

Sinus Characteristics

Answer 25

Dull bilateral pain, pressure behind eyes/face

Question 26

Sinus Onset

Answer 26

With sinus symptoms

Question 27

Sinus Location

Answer 27

Face, forehead, | periorbital area

Question 28

Sinus Duration

Answer 28

Days

Question 29

Tension-Type Symptoms

Answer 29

Headache, neck pain, | scalp tenderness

Question 30

Tension-Type Characteristics

Answer 30

Diffuse ache, tight pressure, constricting pain

Question 31

Tension-Type Onset

Answer 31

Gradual

Question 32

Tension-Type Location

Answer 32

Bilateral, top of head | to base of skull

Question 33

Tension-Type Duration

Answer 33

Minutes to days

Question 34

Headache: Goals of Self-Treatment

Answer 34

1. Reduce severity and alleviate acute pain 2. Restore normal functioning 3. Prevent relapse 4. Minimize adverse effects 5. Reduce frequency of chronic headaches

Question 35

Headache: Patient Education

Answer 35

§ Take appropriate analgesic dose early in course of headache § Trigger avoidance

Question 36

Headache: Evaluation of Patient Outcomes

Answer 36

§ Follow-up depends on frequency and severity | § Refer if persists >10 days or worsens

Question 37

Fever: Pathophysiology

Answer 37

- Defined as core temperature greater than 100 oF (37.8 oC) - Increases in thermoregulatory “set point” may be - Idiopathic

Question 38

Fever may be caused by:

Answer 38

§ Infection § Pathology § Response to medication § Vigorous activity

Question 39

Fever: Complications

Answer 39

Major risks are rare, but may include: § Dehydration § Mental status changes § Seizures

Question 40

Fever: Clinical Presentation

Answer 40

``` §Symptoms are often nonspecific § Most important sign is elevated temperature § Associated signs/symptoms § Anorexia § Arthralgia § Chills § Diaphoresis § Generalized malaise § Headache § Irritability § Myalgia § Tachycardia ```

Question 41

Fever: Detection

Answer 41

``` Considerations § Age § Anatomical site § Environmental temperature § Level of physical/emotional stress § Time of day ``` ``` Routes § Axillary § Oral § Rectal § Temporal § Tympanic ```

Question 42

Fever: Patient Education

Answer 42

§ Treatment should focus on primary cause § Take temperature with an appropriate thermometer § Pharmacologic therapy may take up to 1 day to result in a core temperature decrease § Alternating antipyretics is not recommended

Question 43

Fever: Evaluation of Outcomes

Answer 43

§ Monitor temperature and discomfort | § Refer if persists >3 days (>24 hours if <2 years)

Question 44

Musculoskeletal Pain Acute

Answer 44

§ Pain lasting <4 weeks | § Examples: exacerbation of a condition, sports injuries

Question 45

Musculoskeletal Pain Chronic

Answer 45

§ Pain lasting at least 3 months | § Examples: carpal tunnel, degenerative joint disease, osteoarthritis

Question 46

Myalgia Symptoms

Answer 46

Pain, muscle weakness/fatigue, possible edema

Question 47

Myalgia Characteristics

Answer 47

Dull, constant ache

Question 48

Myalgia Onset

Answer 48

Varies depending on | cause

Question 49

Myalgia Location

Answer 49

Muscles

Question 50

Osteoarthritis Symptoms

Answer 50

Localized pain, joint | stiffness, possible edema

Question 51

Osteoarthritis Characteristics

Answer 51

Dull joint pain

Question 52

Osteoarthritis Onset

Answer 52

Development over years

Question 53

Osteoarthritis Location

Answer 53

Weight-bearing joints

Question 54

Sprain/Strain Symptoms

Answer 54

Pain, tenderness, loss of | function, edema, bruising

Question 55

Sprain/Strain Characteristics

Answer 55

Initial severe pain, continued pain especially with use

Question 56

Sprain/Strain Onset

Answer 56

Acute with injury

Question 57

Sprain/Strain Location

Answer 57

Ligaments/tendons

Question 58

Musculoskeletal Pain: Pharmacologic Therapy

Answer 58

``` §Initial treatment § Systemic nonprescription analgesics § Acetaminophen, NSAIDs §Adjunct therapy § Topical analgesics ```

Question 59

Musculoskeletal Pain Patient Education

Answer 59

§ Early analgesic administration recommended for acute pain | § Preventative measures

Question 60

Musculoskeletal Pain Evaluation of Outcomes

Answer 60

§ Patient’s perception of pain relief | § Refer if persists >10 days or worsens/changes