Migraine Flashcards
1
Q
what is Migraine?
A
- A paroxysmal neurological disorder with many signs and symptoms
- Tension headaches are headaches with muscular origins and are associated with trigger points and other myofascial pain syndromes
- There have been many studies published on migraines, but there is no satisfactory definition for the disorder
- This may be because the symptoms of migraine differ from person to person and even in a single individual or during a single episode
2
Q
Causes of Migraine
A
- Unknown:
Perhaps a CNS disorder that produces secondary intracranial vasodilation followed by vasoconstriction
- Genetics
May play a part
- Triggering Factors:
Stress
Foodstuffs and food additives (n:MSG)
Hunger
Medication
Weather change
Visual stimuli
Auditory stimuli
Olfactory stimuli
Sleeping (n: lack of sleep)
Hormonal shifts
Allergies
- Aggravating Factors:
Movement (n: in certain way)
Trigger points
Postural dysfunction
3
Q
Symptom Picture
A
- Before an attack, many migraine sufferers report fluid retention, stress and fatigue in the 24 hour period before the migraine seems to be a trigger
- Pain is pulsating and of moderate to severe intensity
- Often begins with a full ache or sensation of pressure which gradually localizes to one area and becomes more intense and pounding over several minutes or hours
- Can also begin abruptly, spreading into a more global, throbbing migraine
- These headaches can begin in childhood, adolescence or early adulthood
- Frequency is rarely greater than one per week
- Symptoms can last for 4-72 hours
- Onset is variable, with an early morning onset being common
- Associated symptoms include:
Muscle soreness, hypersensitivity to light and sound, ANS dysfunctions such as GI problems and cutaneous vasoconstriction producing cold extremities and sweating - During the headache, the person withdraws from activity, often to a quiet, darkened room if possible, suffering pain and disability
- Usually the headache resolves over several hours, during sleep or rest
- There may be vomiting or an intense emotional release abruptly ending the migraine
- There is a period of 24-48 hours following migraine resolution termed the “postdrome”, when the person may feel fatigued and drained
4
Q
Migraine without Aura
A
- Formerly called “common migraine”, this condition affects 85% of people with migraines
- In the 24-48 hour period before the migraine, the person experiences premonitory symptoms or alteration of CNS activity
- This may include mood changes, food cravings, altered sensory perception, excessive yawning and memory dysfunction
- These symptoms may originate in the hypothalamus
5
Q
Migraine with Aura
A
- Formerly called “classic migraine”, this affects 15% of people with migraines
- The aura is associated with a reduction in cerebral blood flow
- It develops gradually over 5-20 minutes, lasting for less than an hour and resolving with the headache
- Auras are usually visual, often perceived as flashing lights, zig zag lines or visual distortion
- They may also be sensory, such as a sensation of pins and needles around the lips and hands
- Auditory disturbances include hissing or rumbling noises, while olfactory hallucinations include strong smells such as burning rubber
6
Q
Migraine in Children
A
- Migraine may affect 5% of all children
- In early childhood, boys are more affected than girls; in teen years, migraine is more prevalent in girls
- Headache is less prominent; instead, abdominal pain, cramping, vomiting, episodic vertigo and autonomic symptoms are more common
- While migraines have been reported in infants, they usually first occur after 5 years of age
- Usually one or both parents have a history of migraine
7
Q
Differentiating Other Types of Headaches
A
- With new headaches that begin later in adult life, especially after age 50 (n: increase BP, dehydrate), the client should be referred to a physician
- New primary headaches is rare in the elderly; the headache may be secondary to an underlying pathology
8
Q
High Risk Headaches: Report to Physician
A
- There is onset of a new headache after age 50
- There is onset of a new or different headache (n: slow stroke)
- The client reports the “worst” headache ever experienced
- There is a recent history of acute head trauma
- There is onset of a headache that steadily worsens over time or worsens with exertion, coding or straining
- The headache is associated with changes in neurological status, such as drowsiness, confusion, weakness, loss of coordination and deep tendon reflexes
- A new headache in a person with cancer or HIV
- Headaches is associated with fever and neck rigidity
- The headache is associated with hypertension
9
Q
Warning Symptoms:
Considered Serious and Warranting Immediate Reporting to a Physician
A
- Meningitis:
Signs include severe headache, nuchal rigidity, fever, nausea, vomiting, pain behind the eyes which worsens with eye movement, photophobia and transient rash
- New Headache with a Pregnancy:
- Usually affects client in the 2nd trimester
- Continuous severe frontal or occipital headache, accompanied by visual disturbances, which is not relieved by usual remedies may indicate pregnancy-induced hypertension (pre-eclampsia)
- Brain Tumor:
Pain is generally not severe; however, there are associated neurological signs such as loss of coordination, weakness, dizziness, double vision, nausea, vomiting, lethargy, personality changes and sleep interruption
10
Q
These Symptoms Warrant Early Reporting to the Physician
Within 24 hrs
A
Diabetes Mellitus Hypoglycemia:
(n: have a box of juice with them to drink before, during tx)
- Headache is one of a number of symptoms indicating insulin reaction
- Other symptoms include seating, blurred vision, slurred speech, impaired motor function and tachycardia
- Most people with diabetes will recognize these symptoms and ingest a concentrated carbohydrate sources such as sugar, which is rapidly absorbed
- Temporal Arteritis Pain:
- Persistent and non-throbbing, over the affected artery and inside the eye and associated with diminished pulse in the temporal arteries
- It is usually seen in the elderly client
- Lyme Disease:
- Headache pain is bilateral and gradual in onset, there is an associated skin rash
- It is caused by an infection by spirochete acquired from a tick bite
- Trigeminal Neuralgia Pain:
- Over the distribution of the trigeminal nerve
- Pain occurs several times a day and there are associated facial tics
- Acute Sinusitis Pain:
- Often severe and is located over the affected sinus
- There is a low-grade fever and a feeling of fullness and pressure in the affected sinus with nasal discharge
- Low Pressure Headache Syndrome Pain:
- Aggravated by upright posture and head shaking
- It is relieved in less than 30 minutes by lying down
- Nausea, vomiting and dizziness may also occur
- Some of the causes are lumbar punctures for spinal anesthesia or myelograms which decrease cerebrospinal fluid pressure
11
Q
Mixed and Transformational Headaches
A
- Headaches that share tension and migraine type symptoms are termed “mixed headaches”
- There is often an underlying tension headache with periods of migraine symptoms
- Episodic ( tạm thời) migraine may evolve into chronic near-daily headaches which have been termed a “transformational headache”
- There is a family history of migraine, precipitating factors such as menstruation and migraine-related GI symptoms
12
Q
Symptom Picture:
Mixed and Transformational Headaches
A
- Pain is bilateral with mixed headaches
- Headaches begin when the client is between 20-40 years of age
- Frequency of headaches is often daily
- Episodic headaches have clearly identifiable endpoints, whereas chronic daily and near-daily headaches are constant, with fluctuation in pain levels
- Headache may come on at any time of day
- Associated symptoms are nausea, vomiting, irritable bowel syndrome, sleep disturbances and depression
- Aggravating factors are mental or physical activity
- During the headache, the person presents differently depending on the associated symptoms
13
Q
Cluster Headaches
A
- Cluster headaches are not very common
- They may be caused by abnormal hypothalamic function
- Cluster indicates a grouping of headaches, often once a day for several weeks
- The headache may then disappear for months or years
- There is rarely a family history, however, tobacco use is more prevalent than with any other type of headache
14
Q
Symptom Picture:
Cluster Headaches
A
- Pain of a cluster headache is always unilateral, often periorbital
- May refer into the nose, jaw or teeth
- It is usually severely intense, described as sharp, boring and burning
- They begin when the person is between 20-40 years of age
- During an active cluster period, there may be 1-6 headaches per day (n: 18 hours)
- Symptoms last for 30 mins to 3 hours (n:18 hours)
- Chronic cluster headache occurs when the cluster period exceeds 12 months
- The onset is 1-3 hours after the person goes to sleep
- There are ipsilateral autonomic, dysfunction such as nasal congestion, lacrimation, facial swelling and partial Horner’s syndrome of ptosis (drooping of the eyelid) and miosis (pupil constriction)
- Aggravating factors include vasodilators such as alcohol and reduced oxygen levels experienced at altitudes above 5000 feet
- During the headache, the person is agagitate (khích động )and hyperactive
- It is difficult for the person to find a comfortable position
15
Q
Drug-Associated Headaches
A
- Some headaches are related to medication or drug use
- Certain substances may be effective against headaches, but when taken indiscriminately ( bừa bãi) may cause “rebound headaches”
- Drug-associated headaches often being in the early morning when blood levels of the drug are lower
- The specific drug that causes the headache is required for relief
- Slow reduction of drug levels over a period of several weeks is required for detoxification
