than 180 mm Hg and/or diastolic blood pressure is equal to or greater than 120 mm Hg (Mohammadi et al., 2021). Hypertension is more prevalent in tension-type headaches (55.5%) but also oc- curs with migraine headaches (28.7%; Mohammadi et al., 2021). Febrile illness Headache that accompanies a fever can be the result of several The symptoms of meningitis often include a severe, generalized headache and a high fever. Other symptoms may include neck stiffness, nausea/vomiting, rash, sensitivity to light, joint pain, and seizures. One distinct symptom of meningitis is nuchal rigidity, which limits flexion of the neck (Akaishi et al., 2019). Encephalitis Encephalitis, or infection of the central nervous system, also has headaches that accompany a fever. It is similar to meningitis in that there is often nausea, a stiff neck, and joint pain. However, with encephalitis, there can also be symptoms related to brain dysfunction such as confusion, behavior changes, difficulty speak- ing, trouble moving, memory issues, and loss of consciousness. Influenza and colds conditions. Meningitis Both influenza and colds can cause headache with fever. Accom- panying symptoms with influenza might include chills, muscle aches, fatigue, vomiting, and diarrhea. Cold symptoms typically include sneezing, runny or stuffy nose, sore throat, and coughing. Brain abscess A brain abscess is rare but also involves headache and fever. The accumulation of infected fluid associated with this condition causes an increase in intracranial pressure. In addition to fever and headache, symptoms associated with a brain abscess include neck stiffness, vomiting, confusion, trouble focusing, sleepiness, weakness, language problems, one-sided loss of muscle function, vision changes, and seizures. Sinus infection A sinus infection can cause a fever accompanied by headache with accompanying symptoms of facial tenderness, ear pain, tooth pain, and/or thick nasal discharge. Healthcare consideration: Several types of headaches are associated with fevers. Distinguishing symptoms can be used to determine the origin of febrile headaches. Encephalitis of- ten is accompanied by confusion, behavior changes, difficulty speaking, memory issues, and loss of consciousness. Influenza is accompanied by chills, muscle aches, fatigue, vomiting, and diarrhea, while colds are accompanied by sneezing, runny or stuffy nose, and sore throat. A brain abscess (which is rare) may include neck stiffness, vomiting, confusion, trouble focusing, sleepiness, weakness, language problems, one-sided loss of muscle function, vision changes and seizures. Finally, sinus in- fection includes facial tenderness, ear pain, tooth pain, and/or nasal discharge. Hypoxia High-altitude hypoxia or acute mountain sickness can cause hy- poxia-induced headaches (Barbiani et al., 2018). The decrease in atmospheric pressure at high altitude can trigger blood vessels to swell. Descending to a lower altitude should quickly resolve hypoxia-related headaches (Altitude Sickness: Symptoms, Diag- nosis, Treatment & Prevention, n.d.). Systemic lupus erythematosus Systemic lupus erythematosus is a chronic autoimmune disease that affects younger people. Headache is one of the most com- mon symptoms of patients with this condition (Son et al., 2016). These headaches may present as tension-type, migraine, or non- specific intractable. The cause of headaches with systemic lupus erythematosus is unclear but may be associated with neuronal dysfunction and neurometabolic changes (Son et al., 2016).
ache and brain arteriovenous malformation remains unclear (Lai et al., 2017). Subarachnoid hemorrhage Subarachnoid hemorrhage involves bleeding in the space be- tween the brain and the surrounding subarachnoid membrane and is considered an uncommon but potentially fatal cause of headache (Fernando et al., 2017). “Sudden, worst headache of life” or “thunderclap headache” are widely accepted predictors of subarachnoid hemorrhage (Kimura et al., 2016). The Ottawa Subarachnoid Hemorrhage Rule can be used to identify subarach- noid hemorrhage in people with acute headaches. This rule rec- ommends further investigation if the patient presents with one or more of the following criteria:
● Age 40 years or older. ● Neck pain or stiffness. ● Witnessed loss of consciousness. ● Onset during exertion. ● Thunderclap headache. ● Limited neck flexion on examination. (Perry, 2017)
If these criteria are met and subarachnoid hemorrhage is sus- pected, computed tomography (CT) can rule out this condition (Fernando et al., 2017). Giant cell arteritis; vascular arteritis; temporal vasculitis Giant cell arteritis is a systemic vasculitis involving the large and medium-sized blood vessels, especially the extracranial branches of the carotid arteries (Calvo-Romero, 2003). It is most common in persons older than 50 years of age and can result in permanent vision loss, ischemic stroke, and thoracic and abdominal aortic aneurysm. New onset headache is one of the common symptoms associated with this condition and is typically but not exclusively localized to the temporal areas (Villa-Forte, 2011). Other symp- toms include scalp tenderness, neck pain, malaise, weight loss, fever, and flu-like symptoms (Hayreh, 2021). Case Study: Mrs. Grace Jenkins The client is a 75-year-old female who presents to physical thera- py via referral from her physician for headache of four weeks dura- tion that is constant and located in the right temporal area. She has had intermittent headaches in the past located in the occipital area that have responded well to physical therapy. The evaluating physical therapist is familiar with this client, as they have treated her previous headaches. Compared to previous headaches, this headache has changed location from the occipital area to the right temporal area. In addition, this time the client has tender- ness over the right temporal area. The evaluating physical thera- pist suspects giant cell arteritis. Question How might this physical therapist further confirm the possible presence of giant cell arteritis? Discussion Further symptoms of giant cell arteritis include malaise, weight loss, fever, and flulike symptoms, and the evaluating therapist should inquire about the presence of these symptoms. In addi- tion, vision should be assessed, especially in the right eye. The evaluating physical therapist readily identifies the difference in location and frequency with this new headache (temporal loca- tion, constant frequency) as compared to headaches they have previously treated with this client (occipital location, intermittent frequency). In addition, tenderness over the right temporal area is a red flag for giant cell arteritis. When high suspicion of giant cell arteritis is present, this should be communicated to the physician. Lab tests can confirm the presence of an inflammatory condition. Treatment usually consists of oral steroid medications. Hypertension According to the International Classification of Headache Disor- ders (ICHD), headache associated with arterial hypertension is considered when systolic blood pressure is equal to or greater
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