Chapter 5 - Headache Flashcards
1
Q
Headache
A
- Two types: tension (38%) and migraine (10%)
- Sinus headaches are also reported frequently, but may be misidentified migraines
- May be primary (90%) or secondary (10%) headaches
2
Q
Primary Headaches
A
- Not associated with underlying illness
- EX: chronic/episodic tension headaches, cluster headaches, migraines with or without aura
3
Q
Secondary Headaches
A
- Symptom of an underlying condition
- Ex: Head trauma, stroke, substance abuse, withdrawal, etc.
4
Q
Tension Headaches
A
- Aka stress headaches
- Can be episodic or chronic (15+ days/month for 3+ months)
- Manifest in response to stress, anxiety, depression, emotional conflict, etc.
- Episodic - peripheral source
- Chronic - central mechanism to pain
- Similar pathophysiology to migraine
5
Q
Migraine
A
- Can be with or without aura
- Aura - neurologic symptoms that precede head pain
- Complex interaction of neuronal and vascular factors
- Many triggers
- Can be related to menses in a select few, lack of estrogen and serotonin can cause a similar reaction to start the migraine
- Dysfunction of trigominovascular system causes depolarization that spreads across cerebral cortex
- During headache, stimulation of trigeminal sensory fibers causes release of inflammatory and coagulating factors
6
Q
Sinus Headache
A
- Infection or blockage of paranasal sinuses
- Causes inflammation and distension of sinus walls
- Pain is localized to facial areas
- Can be difficult to differentiate from migraines without aura
- No N/V or visual disturbances
- Persistent sinus pain and discharge could be indicative of infection and could require medical intervention
7
Q
Medication-Overuse Headache
A
-Rebound affect after analgesic withdrawal
-Usually using a non-Rx analgesic more than twice a week for 3 or more months
-Headache occurs within hours of stopping medication
Ex: APAP, caffeine, aspirin, some NSAIDs
-Particularly noticeable upon awakening
8
Q
Clinical Presentation of Headache
A
- Pain severity can vary from not needing to be treated to debilitating
- Shivering and cold temperatures can increase pain in tension-type headaches
- Tension headaches may be accompanied by SOB, constipation, weight loss, fatigue, decreased sexual drive, and menstrual changes
- Aura symptoms: shimmering/flashing areas, blind spots, visual/auditory hallucinations, one-sided muscle weakness, speech difficulty
- Aura symptoms can last up to 30 minutes and headache can last hours to 2 days
- With and without aura symptoms: N/V, photophobia, phonophobia, sinus symptoms, light-headed, aggrivation
9
Q
Headache Treatment Goals
A
- Alleviate acute pain
- Restore normal functioning
- Prevent relapse
- Minimize SE
- Chronic only: reduce headache frequency
10
Q
General Headache Treatment
A
- Episodic - non-Rx, nonpharmacologic, or a combination
- Usually responds well to APAP, NSAIDs, and salicylates (especially if taken at onset)
- Chronic - limit non-Rx to <3 days/week, taper and eliminate if believed to cause medication-overuse headache
- Physical therapy and relaxation exercises may help chronic headache sufferers
- Take analgesic ahead of time if you anticipate a headache
- Sinus headaches - decongestants and sometimes a combination with a non-Rx analgesic
11
Q
Nonpharmacologic Headache Treatment
A
- Relaxation exercises and physical therapy for chronic sufferers
- Regular sleeping, eating, and exercise schedules, stress management, biofeedback and cognitive therapy for migraines
- Ice and cold packs to the temples or forehead
- Good diets, magnesium supplements for migraines
- Avoid red wine, aged cheese, artificial sweetners, caffeine, and chocolate for migraines
12
Q
Pharmacologic Headache Treatment
A
- Select product based on medical history
- May need to additionally treat N/V too
13
Q
APAP - Headaches
A
- Effective analgesic and antipyretic
- Central inhibition of prostaglandin synthesis
- Onset: 30 minutes
- Duration: ~ 4 hours, 6-8 hours with ER formulation
- Food for mild-moderate, nonvisceral pain
- More stringent dosing in children < 12 y.o.
- Can open capsules and place in a cold beverage or soft food for children
- Potential liver damage if taking > 4g/day chronically
- CI: hypersensitivity, chronic/severe liver disease, G6P dehydrogenase deficiency
- Rare, severe SE: Stevens-Johnson syndrome, epidermal necrosis, SCAR
- Interacts with warfarin (increases INR) and alcohol
14
Q
APAP Poisoning
A
- BIG problem
- Symptoms: N/V, drowsiness, confusion, stomach pain (not guaranteed to occur)
- Increased ALT and AST, increased bilirubin, jaundice
15
Q
NSAIDs
A
- Central and peripheral inhibition of COX and prostaglandin synthesis
- Onset: 30 minutes (ibuprofen and naproxen)
- Duration: 12 hours (naproxen) or 6-8 hours (ibuprofen)
- Used for fever and minor pain relief
- Analgesic, antipyretic, and anti-inflammatory
- No changes have been implemented to deal with liquid ibuprofen dosing errors
- Overdoses: minimal symptoms and rarely fatal (GI and CNS effects are most common)
- SE: heartburn, N/V, gastric upset/pain, dizziness, fatigue, weakness
- May be taken with food, milk, or antacids if upset stomach occurs
- Severe SE: rashes, itching, edema, photosensitivity, GI ulcerations, bleeding
- Ibuprofen has significant increased CV risk, making naproxen the safer and preferred option
- *May want to avoid NSAIDs all together with CV disease**
- CI: Renal failure, CHF, renal compromising disease
