Headache Key Questions Name, Age, Onset, Allergies, History of Migraines or Known Aneurysms, Medications, Pain Scale, History. See Head Injury protocol if recent trauma or injury to the head Other Protocols to Consider Alcohol Problems (22); Congestion (145); Head Injury (07); Hypertension (347); Neck Pain (417); Neurologic Symptoms (420); Sinus Problems (556); Toothache (611); Vision Problems (635) Nurse Alert: There are many conditions that cause headaches; some can be potentially life-threatening. Error on the side of caution when triaging callers with a headache. Headache: Causes and Characteristics: Appendix T (698) is provided to help the nurse gain a better understanding of the many conditions causing headaches. It is NOT to be used to try and diagnose a caller's condition. * Be on the alert for signs of meningitis: headache, stiff neck, fever, petechial rash, vomiting, irritability, altered mental status. © Be on the alert for signs of a stroke: headache, weakness on one side of the body, facial drooping, difficulty talking or walking, vision changes. Reminder: Document caller response to advice, home care instructions, and when to call back. ASSESSMENT. ACTION A. Are any of the following present 380© Sudden severe pain or “worst headache ever” © Sudden onset of weakness, unsteady gait, numbness, and/or tingling on one side of the body * Confusion, difficulty in arousing, acting differenely + Sudden onser of difficulty speaking or slurred speech © Stiff neck and fever (pain bending head forward) + Blurred or double vision * Purple or blood-colored flat spots or dots on skin * Child with diabetes and blood glucose is high . Are any of the following present? » Persistent vomiting © History of high blood pressure and light-headedness © Fever > 103°F (39.4°C) and unresponsive to fever- reducing measures + Bye pain with redness and decreased vision » Recent tick bite, headache, rash, and flulike symptoms + New onset of severe persistent pain © Change in ability to walk . Are any of the following present? + Persistent migraine unresponsive to usual migraine treatment * Migraine intensity or character different from past migraines + Persistent headache > 12 hours and no other symptoms * Pain interferes with activity * Pain in temporal areas and age > 50 years . Are any of the following present? © Congestion + Fever and sore throat * Muscles and joints ache © Recent stressful event © History of allergies * Dull and constant pain with tender and tight neck muscles © Recently stopped drinking coffee, eating chocolate, ot smoking © Severe dieting and weight loss 381 “Call ambulance” “Seck emergency GooB “Seek medical care within 2 hours” Gow “Seek medical care within 24 hours” GoD “Call back oF call PCP for appointment if no, improvement” and Follow Home Care Instructions Follow Home Care Instructions* Dental problems Home Care Instructions Headache * Apply cool compresses or ice pack to forehead every 2 hours. © Rest in a quiet darkened room. © Take usual pain medication (aspirin, acetaminophen, ibuprofen). Do not give aspirin to a child. Avoid aspirin-like products if age < 20 years. Avoid acetaminophen if liver disease is present. Avoid ibuprofen if kidney disease or stomach problems exist or in the case of pregnancy. Follow the directions on the label. © Reduce fever with usual fever-reducing measures. © For known migraine: * take medication as directed by PCP * rest with head elevated * apply heat to back of neck + apply cool compresses to forehead + consider avoiding chocolate, milk products, cheddar and blue cheeses, cured pork, caffeine, monosodium glutamate (MSG), and red wine © If nasal congestion is present, breathe steam for 10 to 20 minutes, 4 times a day or use a vaporizer. © Keep a migraine journal and take it to next appointment. Try to identify triggers. Additional Instructions A Report the Following Problems to Your PCP/Clinic/ED © Headache persists > 24 hours 382* No improvement or pain worsens © Fever is present © Thick green or yellow nasal discharge © High blood glucose if you have diabetes © Persistent vomiting A Seek Emergency Care Immediately If Any of the Following Occur » Sudden onset of weakness, numbness, of tingling on one side of the body © Fever, stiff neck © Confusion, severe drowsiness, or difficulty speaking © Purple or blood-colored flat spots or dots appear on skin © Change in ability to walk 1 caller agrees with the advice given, document the eall and encourage the caller to call back or see PCP if the Jem worsens. 3c caller does not agree with the advice given, reevaluate and advise the caller to follow up with PCP, Clini, of ED. 383