Chapter 44

Question 0

Cause of migraine headaches

Answer 0

Mediated by trigeminal nerve
Overreaction of blood vessels in the brain to a triggering event
-spasms in arteries in the base of the brain
-platelets clump together, and serotonin is released (further vasoconstriction)
-other arteries dilate which triggers prostoglandin release (pain)

Question 1

Chronic, episodic migraine headache

Answer 1

Intense pain in none wide of the head, worsening with movement
May see photophobia, or photophobia
Moderate to severe nausea, and vomiting
Usually lasts 4-72 hours

Question 2

Common migraine headache triggers

Answer 2

Caffeine, red wine, stress, MSG

Each pt is different

Question 3

Stages of migraine headache

Answer 3

• Prodromal phase: pt has specific symptoms such as food cravings or mood changes
• Aura phase: (if present) generally involves visual changes, flashing lights, or diplopia (double vision)
• Headache phase: may last a few hours to a few days
• Termination phase: the intensity of headache decreases

Question 4

Migraine without aura

Answer 4

• Migraine begins without and aura before the onset of the headache
• Pain is aggravated by performing routine physical activities
• Pain is unilateral and pulsating
• One of these symptoms is present: n/v, photophobia, photophobia (sound sensitivity), headache lasts for 4-72 hours, migraine often occurs in the early morning, during periods of stress, or in those with premenstrual tension for fluid retention

Question 5

Status migrainous

Answer 5

Headache that lasts longer than 72 hours

Question 6

Migrainous infarction

Answer 6

Neurological symptoms are not completely reversible within 7 days
Ischemic infarct is noted on neuroimaging

Question 7

Unclassified atypical migraine

Answer 7

Headache doesn’t fulfill all of the criteria to be classified a migraine

Question 8

3 “R’s” of migraine headache interventions

Answer 8

Recognize migraine symptoms
Respond and see healthcare provider
Relieve pain and associate symptoms

Question 9

Abortive therapy for migraine headaches

Answer 9

Alleviating pain as soon as started
Started on low doses and then increased as needed
Nursing implications: side effects, adverse reactions, contraindications, other conditions that may effect the migraine or medication

Question 10

Nonspecific analgesics

Answer 10

Acetaminophen, isomeheptene, butalbital

Question 11

NSAIDs

Answer 11

Ibuprofen and naproxen

Question 12

Ergotamine preparations

Answer 12

Imitrex
-Constriction of the intracranial extracerebral blood vessels
-Ergotamine with caffeine 
-sublingual, inhalation, nasal spray
Watch for rebound HAs

Question 13

Prinzmetal’s angina

Answer 13

Angina caused by the constriction of coronary arteries
Must be reported to healthcare provider
Ergotamine preparation

Question 14

Beta blockers

Answer 14

Propanolol, timolol

Must take continuously to prevent calculate changes associated with migraine HAs

Question 15

Tristan preparations

Answer 15

• Agonist effects on serotonin, vasoconstriction, inhibit pro inflammatory neuropeptide release
• do not give within 24 hours of Dihydroergotamin

Question 16

Isometheotene combination

Answer 16

Prevents blood vessel dilation
Midrin
Watch for rebound HAs

Question 17

Anti epileptic drugs

Answer 17

Develope

Top amaz

Question 18

CAM

Answer 18

Yoga
Meditation
Massage
Exercise
Biofeedback
acupuncture and acupressure
Lying down in a darkened room during an attack

Question 19

Triggers to HAs (headaches)

Answer 19

• Food and beverages containing Tyramine, MAOIs, alcohol, aged cheese, caffeine, chocolate, yeast, MSG, nitrates, nuts, artificial sweeteners, smoked fish
• Drugs: cimetidine, estrogens, nitro, procardia
• Other factors: anger, conflict, fatigue, hormonal, light glare, missed meals, psychological stress, sleep problems, smells, travel to different altitude

Question 20

Cluster headache

Answer 20

• Brief (30 minutes - 2 hours)
• Intense unilateral pain
• Cause and mechanism not well known (thought to be related to an overactive and enlarged hypothalamus)
• Pain: excruciating, boring, nonthrobbing, may radiate to forehead, temple, cheek

Question 21

S/Sx of cluster headaches

Answer 21

Ipsilateral (same side) tearing of the eye
Rhinorrheq (running nose) or congestion
Ptosis (drooping eyelid)
Eyelid edema
Facial sweating
Miosis (constriction of pupils