Headache Flashcards

1
Q

Headache pain can arise from both ?

A

Intracranial and extracranial sources

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2
Q

Notes
Pain sensitive structures include
Venous sinuses
Dura
Cranial blood vessels
Divisions of trigeminal nerve
Facial nerve
Glossipharybgeal nerve
Vagus nerve
Cervical nerves

A
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3
Q

Heads aches can be classified as what?

A

Primary vs secondary

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4
Q

What is primary headache?

A

Not caused by disease or another medical condition

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5
Q

What is secondary headaches?
Examples?

A

Caused by another condition or disorder

Sinus infection
Neck injury
Stroke

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6
Q

Primary classifications of headaches
There are 3 types what are they?

A

Tension type
Migraine
Cluster

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7
Q

Can patients have more than one type of headache?

A

Yes

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8
Q

Most frequent site of pain
Think of photo!
Tension type
Migraine
Cluster

A

All around, like a band
One side above the ear
On the eye

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9
Q

What is a tension type headache characterized by?
It’s normally what?

A

Bilateral location and pressing/tightening quality

Mild or moderate intensity

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10
Q

What is the most common type of headache?

A

Tension type

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11
Q

Tension type headache is also known as?

A

Stress headache

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12
Q

Tension type headache can last from
___ to ___
And it’s often subcaterogorizes into (2)

A

Minutes to day
Episodic & chronic

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13
Q

Tension type headache
Etiology and pathophysiology (2)
It’s an increase of what?
And has similar mechanism to what?

A

It’s increased tension in muscles of face, neck and scalp

Mechanism in all patients with tension type headaches has neurovascular factors similar to those involved in migraine headaches

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14
Q

What is the clinical manifestations of tension type headache?
Associated with what?

It may involve?
May occur?

A

Bilateral frontal-occipital discomfort or band like pain

Neck pain

Sensitive to light and sound but no nausea or vomiting

Intermittently for weeks months or years

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15
Q

What is the diagnostic study for tension type headache? (2)
It may reveal what?
It also may not show what during the headache?

A

Careful history taking

EMG may be performed
- reveal sustained contraction of neck, scalp, facial muscles
- may not show increased tension even when test is done during headache

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16
Q

A migraine is a recurring headache that is characterized by? (3)

A

Unilateral or bilateral throbbing pain

A triggering even or factor

Manifestations associated with neurologic and autonomic nervous system dysfunction

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17
Q

Migraine are more common in who?
Men or women?
Prevalence js highest in those of?
__% have a family member with migraine

The most common age is for?

A

Females
Lower socioeconomic status
70%
20-30

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18
Q

Migraine headache
Etiology and pathophysiology
What is cause?
What is involved?
Associated with?

A

It’s unknown for exact cause

Vascular, muscular and biochemical factors are involved

Associated with seizures disorder, ischemic stroke, asthma, depression, MI, anxiety, raynuads, IBS

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19
Q

Migraine headache may be precipitated or triggered by? (3)

A

Menstraution
Head trauma
Physical exertion
Fatigue
Stress
Missed meals
Weather
Drugs
Foods

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20
Q

What types of foods can trigger a migraine?

A

Chocolate
Cheese
Oranges
Tomatoes
Onions
Mono sodium glutamate
Aspartame
Alcohol ( red wine )

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21
Q

Migraine headaches can be preceded by what? (2)

A

Aura and prodrome

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22
Q

Migraine without aura is ?
Migraine with aura Is?

A

Most common type of migraine
10% of migraine episodes

23
Q

Migraine headache
Clinical manifestations
Prodrome can occur days before gm headache
What are the 3 symptoms ?

A

Photophobia
Irritability
Food cravings

24
Q

Migraine aura occurs immediately before a migraine which are? (6)

A

Bright lights
Patchy blindness
Zigzag lines
Sounds
Smells that don’t exist
Motor function symptoms

25
Migraine headaches may last up to how many hours? It’s classified as what? It’s usually a what type of headache? However can switch to the opposite side of the head In what?
4-72hours Steady, throbbing pain that is synchronous with the pulse Unilateral Another episode
26
During a migraine many patients tend to ___ And seek ?
Hibernate Seek shelter from noise, light, odors, people and problems
27
Migraines vary in severity Such as Not all migraines are ___ And some may become progressively ?
Disabling Worse
28
Migraine diagnostic studies ? (4) Test typically are __ No need for specific ___
Patients history Neurologic and diagnostic examinations are normal No specific lab,radiology test Neuro imaging techniques are not recommended unless abnormal findings are found on examination
29
What is a cluster headache? Can occur repeatedly for ?
Most severe and rare form of headache with a sharp stabbing pain Weeks to months at a time followed by period of remission
30
Cluster headache is classified as?
Trigeminal autonomic cephalgia
31
Notes!! Also involves dysfunction of intracranial blood vessels Sympathic nervous system Pain modulation system
32
Cluster headaches clinical manifestation? Where is pain usually located?
Sharp stabbing intense pain typically lasting from a few minutes to 3 hours Around the eye, radiating to the temple, forehead, check, nose, gums
33
Other clinical manifestations of cluster headaches include? (5)
Swelling around the eye Lacrimation (crying) on affected side Facial flushing /pale Rhinitis Construction of pupils
34
During a cluster headache The patient is often agitated and restless; why? How often does it occur? Same time of day as well^? Typically last daily for how many weeks to months Then into remission for ?
Regular Yes 2weeks to 3 months Months or years
35
Cluster headache Diagnosis is based primarily on history But what systems can you do? What is helpful for patients to have too?
CT,MRI,MRA To rule out aneurysm, tumor or infection Headache diary
36
Notes Headaches Other types can be symptoms of serious illness like
Subarachnoid hemorrhage Brain tumors Other intracranial masses Vascular abnormalities Trigeminal neuralgia Disease of eyes, nose, teeth and systemic illness
37
Overall headache symptoms can vary greatly; so it’s important for a nurse to have a thorough clinical evaluation of a persons? (5)
Personality Life adjustment Environment Family situation Neurology / physical status
38
If no systemic underlying disease is the cause, the type of headache guides what??
The therapy
39
What two therapies are used ? Examples?
Symptomatic and prophylactic ? Drugs, medications, yoga, biofeedback, cognitive-behavioral therapy, relaxation training
40
Drug therapy Tension type headache Symptomatic (3) with (2) Prophylactic (4)
Aspirin, acetaminophen, NSAID and sedative muscle relaxant / transquilizer Tricyclic antidepressants Topiramate, divalproex, mirtazapine
41
Drug therapy Migraine Symptomatic This is when it’s mild form !! (3)
NSAID, aspirin, caffeine analgesics
42
Drug therapy for migraine When it becomes moderate or severe What is the first line of therapy? It’s most effect at ___ Affect selected ____ receptors Reduce ____ Produce ___ ( we want to avoid giving this to people who have CAD why? )
Triptans Onset of headache Serotonin Neurogenic inflammation of cerebral blood vessels Vasoconstriction Increases blood clot & because of the plaque
43
Migraine drug therapy Prophylactic (3) This is based on frequent, severity, disability for each individual
Anti seizure drugs Botox Antidepressants
44
Drug therapy Cluster headache Symptomatic Drug therapy isn’t as good, so we do instead?(2)
Inhalation of 100% oxygen at 6-8L/Min for 10/20 minutes Sumatriptan also effective for acute cluster headache
45
NOTES!! Drug therapy Cluster headache Prophylactic
Verapamil Lithium Ergotamine Divalproex Melatonin Anti seizure medication Invasive nerve blockers and ablative neurosurgical procedures have been used for refractory cluster headaches
46
We also want to be very mindful of other type of headaches which can be caused by the potential overuse of analgesics ; like ? (4)
MOH ( medication overuse headache ) ASPIRN, NSAID, Sumatriptain, opioids
47
What is the nursing assessment or a headache? (4)
Asking about health history ( seizures, stroke, cancer ? ) Medications Surgery Treatments
48
You also wanna make sure to ask for the specific location of headache like? L T o f d R
Location Type of pain Onset Frequent Duration Relation to outside events
49
What objective data will you collect from a headache?
Anxiety of apprehension Diaphoressis Pallor Unilateral flushing with cheek edema, conjunctivitis
50
What’s the planning of headache in the nursing management? (4)
Have no pain Demonstrate understanding of trigger events Use positive coping strats Experience increased quality of life
51
Should daily exercise, relaxation periods, socializing help reduce recurrence ?
YES!!!
52
Should you suggest alternative pain management such as relaxation, medication, yoga, and self hyponosis?
YES!!
53
Notes You want to teach the patient to avoid foods triggers, smoking and environmental triggers Encourage dim quiet environment Massage and heat packs Written notes of medications to prevent overdose
54
What is the last goal of evaluation of headaches?
No pain!!! Uses of drugs and non drug measure appropriate to mangane pain