Exam 3 - Headaches, Drowsiness, and Fatigue Flashcards
Are migraines or tension headaches more common
Tension headaches
Migraine: 1.04 billion
Tension: 1.89 billion
Headache epidemiology
- headache disorders are the most common disorder of the nervous system
- associated with pain, disability, and decreased quality of life
What demographics are headaches more common in
Women and younger populations
Headache statistics (prevalence)
- 50% of the world’s adult population has experience HA within the past year
- 5th most common reason for ED visit and accounts for ~3% of all ED visits
- 1 in 6 Americans report severe HA within past 3 months
Health disparities include issues involved in:
Incidence
Prevalence
Migraine-related pain disability
Access to care
Quality of care
(IMPAQ)
What are primary headaches
Headaches that are NOT associated with an underlying illness
HA health disparities affected groups
American Indians
African Americans
Hispanics
Poverty
Unemployed/underemployed
Uninsured/underinsured
People exposed to stress across an extended time period
People experiencing more than one of the above
What are medication overuse headaches considered
Secondary
(Stressed this in class — makes sense because it has a direct cause)
What percentage of HAs are primary HAs
~90%
Examples of primary headaches
Episodic and chronic tension HA
Migraine (with/without aura)
Cluster HAs
What are secondary HAs
Symptomatic of an underlying condition such as:
Trauma
Stroke
Substance use/withdrawal
Bacterial and viral diseases
Craniofacial disorders
Lifestyle modifications
- Stress management
- Cognitive therapy
- Maintaining schedules for: sleep, exercise, and eating
Types of headaches for self treatment
Tension
Migraines
Sinus (simple/minor)
Patient education for HA
Types of headaches/diagnosis
Safe medication use
Lifestyle modifications
HA treatment goals
- Alleviate acute pain
- Restore normal functioning
- Prevent relapse
- Minimize adverse effects
- Reduce frequency of headaches (for chronic)
_______ has shown evidence in helping headaches
Acupuncture
What should be included in a HA diary
Related symptoms
Duration
Frequency
Triggers
Medications that did/didn’t work
Menstruation
***keep for at least 8 weeks
(Really Down For The Moment, Man)
Nonpharmacologic therapy for headache
Pt education
Acupuncture
HA diary
Pressure points for HA relief
Daith ear piercing
Acupuncture in ear
Tension headache pathophysiology
- Response to stress, anxiety, depression, emotional conflict
- Mechanisms are not fully understood
- Genetic and environmental factors involved
The mechanisms of tension HAs are not fully understood. What are they thought to be related to?
Increased sensitivity of central and peripheral pain receptors
What determines if tension headaches are chronic
Occur 15+ DAYS per month for at least 3 months
*Stressed that it is measured in days, not # of HAs
What determines if tension headaches are episodic
Occur LESS THAN 15 days per month
What determines if HAs are FREQUENT episodic
10+ episodes per month
What determines if HAs are INFREQUENT episodic
1 or fewer episodes per month on average
When do tension headaches typically begin
Usually during teenage years
Women are more likely to be affected (3:2)
Tension HA location
Bilateral
Tension HA Nature
Diffuse HA
Tightening
Pressing
Constricting
Non-pulsating
Tension HA Duration
30 min - 7 days
Tension HA Aggravating factors
Stress
Anxiety
Tension HA Intensity
Mild-moderate
Tension HA Onset
Gradual
Tension HA Other symptoms
Scalp tenderness
Neck pain
Muscle tension
Photo OR phonophobia
(Sore Neck Muscles, Probably)
Treatment of episodic tension HAs
Analgesics
Nonpharmacologic treatment
Combination therapy
Analgesics for treatment of episodic tension HAs
Aspirin (Bayer)
OTC and Rx options
NSAIDs:
- ibuprofen (advil, motrin)
- naproxen (aleve)
What is the max self care duration for episodic tension HAs? What is the reason for this max?
3 days per week or 15 days per month
Max exists to prevent medication overuse/chronic tension HA
Nonpharmacologic treatment for episodic tension HAs
Correct posture
Relaxation techniques
Alternative medicine
Physical therapy
(CRAP)
Alternative medicine for treatment of episodic tension HAs
Acupuncture
Massage
Deep breathing/behavioral therapy
Combination therapies for treatment of episodic tension HAs
Combo of aspirin, APAP, ibuprofen, and caffeine
This is more effective than just APAP
Maximum self care use of combination therapies for treatment of episodic tension HAs
10 days/month
Which of the following is a symptom of a tension-type headache
Unilateral pain
Nausea
Sharp pain
Pressure wrapping around the head
Pressure wrapping around the head
To qualify as a migraine (withOUT aura), what characteristics must be present
At least two of the following:
- Unilateral
- Moderate to severe head pain
- Pulsating
- Aggravation by routine physical activity
At least one of the following:
- Photophobia/phonophobia
- Nausea/vomiting
Before a migraine can be self treated, what must the patient have
Medical diagnosis of migraines
Migraine WITH aura
Patients experience neurologic signs/symptoms that precede or coincide w/ the onset of head pain and then resolve fully
Neurologic manifestations of migraines WITH aura
- Ocular perceptions of shimmering/flashing areas or blind spots
- Difficulty speaking (rare)
- Visual and auditory hallucinations
- Muscle weakness (usually one sided)
(Our Damn Vicious Migraines)
How long can neurologic symptoms of migraines WITH aura last
Neurologic symptoms may last up to 60 minutes
Subsequent head pain lasting hours-days
When is a migraine considered to have aura
In patients with or without headache if neurologic symptom:
- develops slowly over 5 min
- lasts 5-60 min
- resolves completely
For migraines WITH aura, head pain does NOT ________
Have to follow aura signs
If a patient is having a migraine, how might they describe the pain
As being one side of the head (unilateral)
phases of a migraine in order
Prodrome
Aura
Headache
Postdrome
(Pretty Awful Headaches, Pal)
Prodrome/premonitory
Pre-headache
Can being hours to days before headache
One or more signs occurring before clinical onset of migraine (ie head pains)
Prodrome/postdrome signs
Food cravings
Yawning
Neck pain/stiffness
Hyperactivity/hypoactivity
Fatigue
Depression
(Fuck Your New Hoe For Days)
Aura
No headache pain
Usually evolves over 5 minutes and lasts 60 min
Does not have to occur with every headache
Postdrome
Recovery period/migraine hangover
Not experienced by everyone
One or more signs occurring after the migraine episode (after pain is fading or gone)
Headache
Lasts several hours to days
Pain levels vary
Pain can shift from one side of the head to the other
Migraine triggers
Dehydration
Hormonal changes
Miscellaneous
Environmental
Food/diet
(Don’t Have Migraines Every Friday)
Migraine triggers: dehydration
- major cause
- address dehydration for all patients, especially children
Migraine triggers: Hormonal changes
- menopause and menstruation
- medications such as hormonal contraceptives/other hormone therapies
Migraine triggers: Food/diet
- MSG
- Nitrates (cured meats)
- Caffeine/caffeine withdrawal
- Saccharin/aspartame (phenylalanine)
- Fermented/pickled foods
- Alcohol
- Chocolate (theobromines)
- Tyramine (red wine, aged cheeses
- Skipping meals/ low blood sugar
(Might Not Catch Straight FACTS)
Migraine triggers: Environmental
- Fumes/odors (cleaning solution, paints, gas)
- Tobacco smoke
- Noises
- Fragrances
- Allergies
- Weather changes
- Bright lights
- High altitudes
(Fuck Those New Fake Ass Wanna Be Hoes)
Migraine triggers: Miscellaneous
Sleep deprivation or excess
Head trauma
Anxiety
Physical exertion
Eye strain
Stress/post stress (most common)
(SHAPES)
Preventative treatments for migraines
Daily therapy to reduce frequency, severity, and duration
Patients w/ frequent HA may need both preventative and acute therapies
NOT self treatments (require rx)
Preemptive care for migraines
Used when known trigger exists
Ex. Menstruation
Acute care for migraines
Medications may be taken during the attack
Used to relieve pain and stop progression
May be best treatment plan in HA are infrequent, pt is non-compliant, or preventative treatment is not tolerated
