I feel dizzy and my head hurt, should I see doctor or a nurse?

By: | Tags: | Comments: 0 | September 15th, 2020

Honey , my head hurts slightly, I felt dizzy in the shower this morning when I was getting ready for work , but I have just called them at work, I will work from home today  .

I will just take it easy today . No big deal.

Sweetheart, I think you need to see a doctor!

Really , I am perfectly fine, I do not have see one now, I will watch it, if the headache is not better by lunch time , I might drive in to the urgent care next to the house to see that doctor .

Doctor – My wife made  me to come today because I felt dizzy today while having a shower and I have this headache back of my head . I feel great now , but I know she is a nagging and she would not get off my back unless I have seen a doctor  , so am just here to get your blessing so that I can tell my wife that the doctor said I am OK,

Objectives:

  • Differentiate between priamary and secondary headache
  • Identify the Redflags / Danger zones for headahce
  • Er visit now vrs I will see my doctor in the am
  • Low risk factors for headache

Are there different types of headaches

There are different types of headache. The 2 most common types are:

  1. Tension headaches – Tension headaches cause pressure or tightness on both sides of the head.
  2. Migraine headaches – Migraine headaches often start off mild and then get worse. They often affect just 1 side of the head. The pain often feels like it is pounding or throbbing. Routine activities like walking or climbing stairs can make the headache worse. Migraines can also cause nausea or vomiting, or make you sensitive to light and sound.

As many as 90 percent of all primary headaches fall under a few categories, including migraine, tension-type, and cluster headache. While episodic tension-type headache (TTH) is the most frequent headache type in population-based studies, migraine is the most common diagnosis in patients presenting to primary care physicians with headache.

Cluster headache typically leads to significant disability and most of these patients will come to medical attention. However, cluster headache remains an uncommon diagnosis in primary care settings because of overall low prevalence in the general population

Headaches can be categorized as

  • Migriane Headache
  • Tension Headache ‘
  • Cluster Headache
  • ‘Secondary Headache

Migraine is a disorder of recurrent attacks. The headache of migraine is often but not always unilateral and tends to have a throbbing or pulsatile quality. Accompanying features may include nausea, vomiting, photophobia { light sensitivity }, phonophobia{ persistent abnormal and unwarranted fear of sound}, or osmophobia { aversion to smell or odor } during attacks. Migraine trigger factors may include stress, menstruation, visual stimuli, weather changes, nitrates, fasting, wine, sleep disturbances, and aspartame, among others

The typical presentation of a TTH attack is that of a mild to moderate intensity, bilateral, non-throbbing headache without other associated features. Pure TTH is a rather featureless headache

Cluster headache belongs to a group of idiopathic headache entities, the trigeminal autonomic cephalalgias, all of which involve unilateral, often severe headache attacks and typical accompanying autonomic symptoms. Cluster headache is characterized by attacks of severe unilateral orbital, supraorbital, or temporal pain accompanied by autonomic phenomena,

Cluster headache may sometimes be confused with a life-threatening headache, since the pain from a cluster headache can reach full intensity within minutes. However, cluster headache is transient, usually lasting less than one to two hours.

Unilateral autonomic symptoms are ipsilateral to the pain and may include ptosis, miosis, lacrimation, conjunctival injection, rhinorrhea, periorbital edema, facial sweating, and nasal congestion. Restlessness can also be a typical feature of a cluster headache attack. Attacks usually last 15 to 180 minutes.

Secondary headache caused by an underlying condition is termed a secondary headache. Clinicians who evaluate patients with headache should be alert to signs that suggest a serious underlying disorder A headache caused by an underlying condition is termed a secondary headache . Clinicians who evaluate patients with headache should be alert to signs that suggest a serious underlying disorder

EVALUATION OF HEADACHES

Appropriate evaluation of headache complaints includes the following:

  • Rule out serious underlying pathology and look for other secondary causes of headache.
  • Determine the type of primary headache using the patient history as the primary diagnostic tool . There may be overlap in symptoms, particularly between migraine and tension-type headache (TTH) and between migraine and some secondary causes of headache such as sinus disease. A headache diary can be helpful in further clarifying the headache diagnosis, the frequency of headache, potential triggers, and the disability from the headache

A thorough history can focus the physical examination and determine the need for further investigations and imaging exams. A systematic history should include the following:

●Age at onset

●Presence or absence of aura and prodrome

●Frequency, intensity, and duration of attack

●Number of headache days per month

●Time and mode of onset

●Quality, site, and radiation of pain

●Associated symptoms and abnormalities

●Family history of migraine

●Precipitating and relieving factors

●Exacerbation or relief with change in position (eg, lying flat versus upright)

●Effect of activity on pain

●Relationship with food/alcohol

●Response to any previous treatment

●Review of current medications

●Any recent change in vision

●Association with recent trauma

●Any recent changes in sleep, exercise, weight, or diet

●State of general health

●Change in work or lifestyle (disability)

●Change in method of birth control (women)

●Possible association with environmental factors

●Effects of menstrual cycle and exogenous hormones (women)

Low risk features for headache

The following features can serve as indicators of patients who are unlikely to have serious underlying cause for headache

Age ≤50 years

●Features typical of primary headaches

●History of similar headache

●No abnormal neurologic findings

●No concerning change in usual headache pattern

●No high-risk comorbid conditions

●No new or concerning findings on history or examination

Danger signs for headache

Danger signs — Paying attention to danger signs is important since headaches may be the presenting symptom of a space-occupying mass or vascular lesion, infection, metabolic disturbance, or a systemic problem. The following features in the history can serve as warning signs of possible serious underlying disease

Systemic symptoms including fever

Neoplasm history

Neurologic deficit (including decreased consciousness)

Onset is sudden or abrupt

Older age (onset after age 50 years)

Pattern change or recent onset of new headache

Positional headache

Precipitated by sneezing, coughing, or exercise

Papilledema

Progressive headache and atypical presentations

Pregnancy or puerperium

Painful eye with autonomic features

Post-traumatic onset of headache

Pathology of the immune system such as HIV

Painkiller (analgesic) overuse (eg, medication overuse headache) or new drug at onset of headache

Any of these findings should prompt further investigation, including brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT).

  • Strictly unilateral pain that does not switch sides (ie, side-locked pain) is associated with an increased likelihood of secondary headache disorders (especially cervicogenic headache and post-traumatic headache), although only a minority may be related to a serious underlying disease
  • Impaired vision or seeing halos around light suggests the presence of glaucoma. Suspicion for subacute angle closure glaucoma should be raised by relatively short duration (often less than one hour) unilateral headaches that do not meet criteria for migraine arising after age 50
  • Visual field defects suggest the presence of a lesion of the optic pathway (eg, due to a pituitary mass).
  • Sudden, severe, unilateral vision loss suggests the presence of optic neuritis. Optic neuritis typically presents with painful, monocular visual loss that evolves over several hours to a few days. One-third of patients have visible optic nerve inflammation (papillitis) on funduscopic examination
  • Blurring of vision on forward bending of the head, headaches upon waking early in the morning that improve with sitting up, and double vision or loss of coordination and balance should raise the suspicion of raised intracranial pressure (ICP); this should also be considered in patients with chronic, daily, progressively worsening headaches associated with chronic nausea.
  • In patients who present with headache that is relieved with recumbency and exacerbated with upright posture, the diagnosis of headache attributed to spontaneous intracranial hypotension, or to spontaneous spinal cerebrospinal fluid (CSF) leak with normal CSF pressure should be considered. The presence of nausea, vomiting, worsening of headache with changes in body position (particularly bending over), a focal neurologic deficit, papilledema, new-onset seizure, and/or a significant change in prior headache pattern suggests a brain tumor as a possible cause. The features of brain tumor headache are generally nonspecific and vary widely with tumor location, size, and rate of growth. Brain tumor headache may resemble tension-type headache, migraine, or a variety of other headache types
  • Morning headache is nonspecific and can occur as part of a primary headache syndrome or may be secondary to a number of disorders including sleep apnea, sleep-related bruxism, chronic obstructive pulmonary disease, caffeine withdrawal, medication overuse headache, and the obesity-hypoventilation syndrome

Need for emergency evaluation — A small proportion of patients present with serious or life-threatening headaches that require referral for emergency diagnosis and treatment. These include:

Sudden onset “thunderclap” headache – Severe headache of sudden onset (ie, that reaches maximal intensity within a few seconds or less than one minute after the onset of pain) is known as thunderclap headache because its explosive and unexpected nature is likened to a “clap of thunder.” Thunderclap headache requires urgent evaluation as such headaches may be harbingers of subarachnoid hemorrhage and other potentially ominous etiologies

Acute or subacute neck pain or headache with Horner syndrome and/or neurologic deficit – Cervical artery dissection is usually associated with local symptoms including neck pain or headache, and often results in ischemic stroke or transient ischemic attack. Horner syndrome is seen in approximately 39 percent of those with carotid and 13 percent of those with vertebral artery dissection .

Headache with suspected meningitis or encephalitis – Fever, altered mental status, with or without nuchal rigidity may indicate central nervous system infection.

Headache with global or focal neurologic deficit or papilledema – Headache is the primary symptom of increased ICP, which should be suspected when accompanied by bilateral papilledema, focal neurologic deficit, or repeated episodes of nausea and vomiting.

Headache with orbital or periorbital symptoms – Headache with visual impairment, periorbital pain, or ophthalmoplegia could indicate acute angle closure glaucoma, infection, inflammation, vascular congestion from a cavernous sinus thrombosis or draining arteriovenous malformation, or tumor involving the orbits.

Headache and possible carbon monoxide exposure – Headache is a nonspecific symptom of carbon monoxide exposure; the intensity varies with the carbon monoxide level [1]. The headache tends to be bilateral and mild at low levels of carbon monoxide, pulsating at levels of 20 to 30 percent, and severe with nausea, vomiting, and blurred vision at levels of 30 to 40 percent.

Should I see a doctor or a Nurse for my Headache ?

See a doctor or nurse right away if:

●Your headache comes on suddenly, quickly becomes severe, or could be described as “the worst headache of your life”

●You have a fever or stiff neck with your headache

●You also have a seizure, personality changes or confusion, or you pass out

●Your headache began right after you exercised or had a minor injury

●You have new headaches, especially if you are pregnant or older than 40

●You have weakness, numbness, or trouble seeing (migraine headaches can sometimes cause these symptoms, but you should be seen right away the first time these symptoms happen)

You should also see a doctor or nurse if you get headaches often or if your headaches are severe.

Some people find that their headaches are triggered by certain foods or things they do. To keep from getting headaches in the future, you can keep a “headache calendar.” In the calendar, write down every time you have a headache and what you ate and did before it started. That way you can find out if there is anything you should avoid eating or doing. You can also write down what medicine you took for the headache and whether or not it helped.

Some common headache triggers include:

    • ●Stress
    • ●Skipping meals or eating too little
    • ●Having too little or too much caffeine
    • ●Sleeping too much or too little
    • ●Drinking alcohol
    • ●Certain drinks or foods

If your headaches are frequent, severe, or long-lasting, your doctor can suggest ways to try to prevent them. For example, it might help to learn relaxation techniques and ways to manage stress. In some cases, medicines can also help.

Back  to the  patient , he was older than 65 year old and he has all the  redflags for Danger headaches, patient was sent for immediate CT of the brain with IV Contrast which revealed that he has a severe head bleed. He was then referred to Neurosurgeon . Patient had the appropriate study done in a timely fashion and the outcome was good

Feel free to call 1st Class urgent care center and our Board Certified ER Physician will be willing to talk to you  and steer you in the right direction .

Take home message – Listen to your wife

Dr Joseph Taiwo

HOW WE KEEP YOU SAFE!


When you visit 1st Class urgent care , your safety is our number one priority .
All our staff wear full PPE (protective personal equipment) masks, gloves and we have routine cleaning according to CDC guidelines
We have also made changes to our waiting room to accommodate more spaces for social distancing to minimize contacts.
Also while you are in the exam room being tested or examined, our providers wear protective clothes mask and face shield when they collect the samples.

Joseph Taiwo MD

You must be logged in to post a comment.

Covid-19 Antibody Testing is Now Available by Appointment

If you think you have been exposed to COVID‑19 and you are asymptomatic and you want to know your status or you need negative report to go back to work, Please schedule Antibody Testing Appointment Now. Visit our page for more information on Coronavirus