Headache for the Correctional Nurse

Headache is a pain in any part of the head, including the face, scalp, and interior of the head. The pain is due to activation of the pain-sensitive structures around the brain, skull, face, teeth or sinuses. It is the one of the most common types of pain seen in the outpatient setting, and conditions like migraine and chronic headaches are associated with other morbidities, like depression.  

Headache may present as a primary disorder, or as a secondary condition to another disorder. Primary headache disorders include migraines; tension-type headaches; and cluster headaches.  Disorders causing secondary headache include extra cranial disorders (dental problems like infection and temporal mandibular joint dysfunction; carotid or vertebral artery dissection; sinusitis and glaucoma), intracranial disorders (brain tumor, Chiari malformation, Central Spinal Fluid (CSF) leaks, infection, hemorrhage and vascular disorders; systemic disorders like severe hypotension, bacteremia, fever, giant cell arteritis, hypercapnia, hypoxia and viral infections; and drugs and toxins (analgesia overuse, caffeine withdrawal, carbon monoxide exposure, hormones, nitrates and proton pump inhibitors).  It is very important that a secondary cause of headache be ruled out before a diagnosis of primary  headache is made.  

In this class we will discuss three common types of primary headaches correctional nurses are likely to encounter in the correctional environment – migraine, tension and cluster, and we will discuss secondary headaches that might be seen.  We will review the subjective and objective information needed for an appropriate patient assessment that will be shared with a provider so that a correct diagnosis can be made, and we will review the red flags that indicate a potential emergency situation needing prompt intervention.