Headaches are a common condition. Typical symptoms include a mild to painful throbbing or tight sensation in the head, pain behind the eyes (especially when looking at bright lights), dizziness, and in more extreme cases nausea or vomiting. A migraine is a type of headache that is often reoccurring. Usually, a headache does not have a serious cause and will pass, however, in some cases, it can indicate a more serious condition. First aid providers should seek to understand the probable cause of the headache.
Guidelines
- If a person experiences a tension-type headache or an acute migraine headache, the first aid provider should advise them to take 1000 mg of paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. **
Good practice points
- Paracetamol and other painkillers should only be used if a headache results from minor causes such as tiredness or stress.
- Applying an ice pack or cold compress to the head or back of the neck may provide relief from migraine symptoms.
- Bright lights (e.g., from an office or phone screen) may make a headache or migraine worse. If the individual with either condition is sensitive to light, they should sit or lie in a dark or dimly lit room to increase comfort and reduce the pain.
- Individuals with a headache should get fresh air, enough sleep, regularly drink water (see Dehydration) and take time to relax.
Chain of survival behaviours
Prevent and prepare
- Understanding the causes of headaches can help to prevent their occurrence. Headaches can be
caused by:
> stress
> poor sleep
> flu or cold
> meningitis
> Hyperthermia
> Head injury
> Dehydration
> alcohol consumption.
The use of painkillers such as paracetamol is most effective when taken at the early stages of the onset of pain. Taking a painkiller at the first sign of a headache may prevent a more severe one from developing.
Early recognition
A person may have a headache if they:
- have pain behind their eyes
- feel a tightness around their head
- have painful throbbing in their head
- have an increased sensitivity to noise or light
- are nauseous.
The condition may indicate another more severe condition if the headache is accompanied by:
- fever
- vomiting
- skin rash
- memory loss
- neck pain or stiffness
- coordination problems
- problems with eyesight
- drowsiness or sleepiness.
______________________________
NOTE
The pain caused by a headache can range in frequency and severity.
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First aid steps
- Reduce anything that may worsen the headache (such as direct sunlight or noise).
- Advise the person to take 1000 mg of paracetamol.
- Advise them to rest in a dark, quiet room. It might help to put an icepack or cold compress on their head or neck.
Access help
Sometimes headaches can indicate a more serious disorder. Access emergency medical care if the headache is severe and is accompanied by:
- vomiting
- a sore or stiff neck
- a rash, as this may indicate meningitis
- memory loss
- double or blurred vision
- fever
- signs of a Stroke.
Or if the severe pain:
- follows a Head injury
- becomes worse very fast
- occurs during exertion (e.g., exercise) or a change in posture
- started suddenly within the last three months of pregnancy
- does not go away even after taking painkillers or reducing potential causes.
Recovery
- Continue taking painkillers for frequent tension headaches if it is safe to do so.
- Follow any recovery instructions from the healthcare professional.
Education considerations
Context considerations
- Areas with limited resources may not have painkillers readily available. Emphasise rest, hydration, relaxation techniques and a cool cloth on the forehead or neck as effective first aid support for mild headaches.
- Follow your local regulations on who can administer non prescribed painkillers as the regulations overrule these guidelines.
Facilitation tips
- Plan to facilitate the topic of headaches after other critical first aid skills so that learners are better able to contextualise what a headache might indicate.
- Emphasise that while most headaches are usually not serious, they may be a symptom of a more severe condition and learners must recognise the situations in which to access medical care.
- Use scenarios as a way to connect headaches to other illnesses and injuries within first aid. For example, run two to three scenarios where the person’s headache is caused by something different. Learners must identify what the cause is and provide appropriate care.
Learning connections
- Use this topic to practise assessment skills such as asking about the history of the person’s symptoms. (See General approach.)
- Draw connections to other topics within first aid when exploring headaches such as recognising signs of meningitis, Head injury and Stroke.
Scientific foundation
Systematic reviews
We used a 2020 evidence summary by the Centre for Evidence-Based Practice (CEBaP), as well as an additional systematic review from 2010 on the topic of headaches.
CEBaP identified a Cochrane systematic review, including 23 randomised controlled trials, on the use of paracetamol for tension-type headaches, and selected five relevant randomised controlled trials from a second Cochrane review about the use of paracetamol for acute migraine headaches.
There is limited evidence in favour of using paracetamol for acute migraine headaches. It was shown that 1000 mg paracetamol resulted in a statistically significant decrease of acute migraine headache, adverse events, functional disability and use of rescue medication compared to placebo. Evidence is of moderate certainty and results cannot be considered precise due to the low number of events and large variability of results.
In addition, there is high-certainty evidence in favour of using paracetamol for tension-type headache. It was shown that 1000 mg paracetamol resulted in a statistically significant decrease of tension-type headache and use of rescue medication, compared to placebo. A statistically significant decrease of tension-type headache and use of rescue medication, using 500-650 mg paracetamol compared to placebo, could not be demonstrated.
A systematic review from 2010 (Verhagen et al., 2010) evaluated the effectiveness of NSAIDs in people with tension-type headache. The evidence showed that NSAIDs are more effective than a placebo medication for short-term pain relief. When comparing NSAIDs and paracetamol there was a significant difference in favour of using NSAIDs. The review found no significant differences between the different types of NSAIDs, but ibuprofen showed fewer short-term side effects.
This review also concluded there is insufficient evidence for or against the effectiveness of the preventive medication, physiotherapy, (spinal) manipulation or cognitive behavioural treatment in people with tension-type headache.
Non-systematic reviews
One randomised controlled crossover clinical trial evaluated the benefits of cooling the blood that passes through the carotid arteries versus no cooling treatment. An adjustable wrap containing two ice packs targeting the carotid arteries at the neck (where they come close to the skin’s surface) was used as the cooling mechanism. A total of 55 participants completed the study successfully. They observed maximum pain reduction at 30 minutes, with a 31.8 ± 15.2 per cent decrease in pain in the treatment arm (where cooling was applied) compared to a 31.5 per cent ± 20.0 per cent increase in pain at the same time interval in the control arm (no cooling). The study found that a frozen neck wrap, applied at the onset of a migraine, targeting the carotid arteries in the neck, significantly reduced the pain for participants with a migraine (p<.001) (Sprouse-Blum et al., 2013).
References
Systematic reviews
Centre for Evidence-Based Practice, Belgian Red Cross-Flanders. (2020). Evidence summary Headache – Paracetamol. Available from:
https://www.cebap.org/knowledge-dissemination/first-aid-evidence-summaries/
Verhagen, A., Damen, L., Berger, M., Lenssinck, M. L., Passchier, J., & Kroes, B. W. (2010). Treatment of tension type headache: paracetamol and NSAIDs work: a systematic review. Nederlands tijdschrift voor geneeskunde, 154(27).
Non-systematic reviews
Sprouse-Blum, A. S., Gabriel, A. K., Brown, J. P., & Yee, M. H. (2013). Randomized controlled trial: targeted neck cooling in the treatment of the migraine patient. Hawai’i Journal of Medicine & Public Health, 72(7), 237.
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Published: 15 February 2021
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