joint pain. However, with encephalitis, there can also be symptoms related to brain dysfunction such as confusion, behavior changes, difficulty speaking, trouble moving, memory issues, and loss of consciousness. Influenza and colds Both influenza and colds can cause headache with fever. Accompanying 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 often 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 infection includes facial tenderness, ear pain, tooth pain, and/or nasal discharge. Hypoxia High-altitude hypoxia or acute mountain sickness can cause hypoxia-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, Diagnosis, 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 common symptoms of patients with this condition (Son et al., 2016). These headaches may present as tension-type, migraine, or nonspecific 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). The possible underlying mechanisms for the association between sleep apnea and headaches include vibration from snoring, intermittent hypoxia, hypercapnia, arousals, sleep fragmentation, disturbances in cerebral blood flow regulation, and transient intracranial pressure increases (Park et al., 2021). According to Park et al. (2021), the treatment of sleep apnea has been shown to alleviate sleep-related headaches.
Case Study: Mrs. Grace Jenkins The client is a 75-year-old female who presents to physical therapy via referral from her physician for headache of four weeks duration 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 tenderness over the right temporal area. The evaluating physical therapist 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 addition, 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 location, 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 Disorders (ICHD), headache associated with arterial hypertension is considered when systolic blood pressure is equal to or greater 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 occurs with migraine headaches (28.7%; Mohammadi et al., 2021). Febrile illness Headache that accompanies a fever can be the result of several conditions. Meningitis 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 Pulmonary system Obstructive sleep apnea Obstructive sleep apnea is caused by repetitive obstruction of the upper airway that results in partial or complete blockage of airflow and affects 3% to 20% of the general population (Park et al., 2021). Sleep apnea headache is included in the International Classification of Headache Disorders under the heading of headache due to disorder of homeostasis. Of patients with the diagnosis of sleep apnea, 15% to 60% suffer from headaches (Park et al., 2021).
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