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Case Study: Severe Headaches – Benign or Life Threatening? Advice by Nurse Triage Can Save Lives
On a daily basis, healthcare professionals see patients who are seeking relief from either acute or chronic headaches. Many headaches are caused by stress, an unhealthy diet or lifestyle, or the overuse of some medications. Almost everyone suffers from a headache at some point during their life, but in some instances a headache can be life threatening.
Take for instance the case of, Jane Smith, CEO of a small company in Charleston, SC. Jane is a healthy woman in her early 40’s who exercises regularly and eats a balanced healthy diet. She does not smoke or have other habits that would put her at high risk for health-related problems. Her past medical history is significant only for a history of thyroid cancer, for which she underwent a thyroidectomy 15 years earlier.
One evening while vacationing in Miami, Jane reported feeling the onset of a pretty severe headache as she was getting ready for dinner. The family had been out in the sun all day. She attributed her headache to hunger or dehydration. She continued to get ready for her evening dinner plans, trying to ignore her increasing pain. As she was eating dinner, she reports the room began to spin and she remembers telling her husband “I don’t think I can handle this anymore.”
Jane’s husband, who is a physician, performed a neurological assessment to make sure she was stable and then called Nurse Triage. The nurse on the phone first ensured his wife was stable (she was breathing normally and her neurological status was intact). After collecting a brief health history, the nurse opened her Headache Protocol and began her assessment. The nurse quickly reviewed symptoms that would require activating EMS. Because of the severity of Jane’s headache, as she describes it “the worst headache of her life”, she and the nurse settled on needing to be seen in the Emergency Department (ED) immediately.
Jane was taken to the nearest ED where she was evaluated by a neurologist who ordered a STAT CT scan, which revealed a bleed related to an AVM (arteriovenous malformation). Jane’s condition required urgent surgical correction and, thankfully, because of her early intervention and the quick actions of a neurosurgeon, her outcome was positive and she has made a complete recovery. Without timely treatment, the outcome could have been fatal.
While many headaches are corrected by making healthy lifestyle changes, reducing stress or using cool compresses and resting in a dark, quiet area, there are some headaches and symptoms that should not be minimized or ignored. This is where Nurse Triage can help a difference in the patient’s outcome.
Telephone triage nurses assess patients with headaches either as the main symptom or in association with other symptoms. Triage nurses use specialized protocols to guide themselves and the patient through a series of questions to determine the severity of their symptom/s. The protocols, like those used in the case above, begin by ruling out the most urgent symptoms associated with a symptom. In this case, difficulty awakening, acting confused, disoriented or having slurred speech are the most urgent. Any new onset of weakness or numbness to one side of the body or loss of speech should also be red flags to the triage nurse that Emergency Medical Services (EMS) should be activated immediately (Thompson, D. 2014 triage protocols).
Conclusion: According to the National Institute of Health, headaches are the most common form of pain and are a major reason people miss days at work or school or visit the doctor. Not every headache warrants a visit to the physician, but there are some warning signs that could indicate a more serious disorder. Any sudden onset of a severe headache, a headache following a blow to the head, or any headache associated with a stiff neck, fever, confusion, loss of consciousness, or pain in the eye or ear requires evaluation by a medical professional right away.
 The patient’s name and details have been changed to protect her privacy.
What to read next: How do Triage Nurses Evaluate if a Headache is Serious?
“Hi I’m Dr. Ravi Raheja, the medical director for Triage Logic. Most people, at some point, have experienced a headache. Almost all headaches resolve on their own, and have no serious side effects. However, some headaches can be a sign of something more serious and even life threatening. So how do you know if a headache is serious?”
“Well, there are certain symptoms you need to be aware of.”
- “If a headache comes on really suddenly and is extremely severe, than that may be a sign of something more serious.”
- “Any headache after a head injury is something that could be potentially harmful.”
- “If a headache is associated with other symptoms like fever, stiff neck, loss of consciousness, altered consciousness, or pain in the eyes or ears, than that is something that needs to be evaluated by a medical professional right away.”
“If you read this article, you’ll learn more about how a simple headache, or what seemed like a simple headache, turned out to be a much more severe, unexpected stroke.”