Test 3 Headaches (CNS, Brain) Flashcards
What are the 2 types of headaches?
Migraine headaches
Cluster headaches
What are the risk factors for headaches in general?
- Alcohol
- Environmental allergies
- Medication
- Intense odors, bright lights
- Fatigue, sleep deprivation
- Depression
- Emotional/physical stress, anxiety
- Menstrual cycle, oral contraceptive use
What are the Foods (triggers or risks for headaches)?
(Triggers or risk factors for heachaches)
Food containing tyramine: (nuts, pickles, caffeine, beer, wine, aged cheese, artificial sweeteners, sugar-free beverages)
caffeine, monosodium glutimate (MSG), nitrites, milk products
What is the pathology is migraines?
Migraines are Multifaceted:
- Vascular
- Genetic
- Neurological
- Hormonal
- Environmental
What are the symptoms of migraines?
Migraine symptoms:
- Intense pain, UNILATERAL (often behind one ear or eye)
- Descriptor –> Throbbing
- Worsens with movement
- Photophobia or phonophobia (sensitive to sound)
What are the 3 categories of migraine?
Migraines have 3 categories:
- Aura (Classical migraine)
- No aura (Common migraine)
- Atypical
Migraines:
What are the stages or phases of the Aura category?
Aura category:
-Prodromal stage
-Aura stage
-Second stage
-Third stage
Sense of migraine coming on
Migraine: With Aura
What is the prodromal stage?
Include awareness of findings for hours to days before onset: irritability, depression, food cravings, diarrhea/constipation, and frequent urination
Migraine: With Aura
What is the Aura stage?
Develops over minutes to an hour and includes: numbness/tingling of mouth, lips, face, or hands; visual disturbances (lights flashes, bright spots)
Migraine: With Aura
What is the Second stage?
Severe, incapacitating, throbbing headache that intensifies over several hours and is accompanied by nausea, vomiting, drowsiness, and vertigo (dizzy spells)
Migraine: With Aura
What is the Third stage?
(4 to 72 hours)
Headache dull
Older adults may continue with aura, and pain subsides (visual migraine)
Migraines:
What are the characteristics of the No Aura (common migraine) category?
No aura:
- 4 to 72 hours duration
- Pain aggravated by physical activity
- One or more of these present: photophobia, phonophobia, nuasea, and/or vomiting
- Unilateral, pulsating pain
Migraines:
What are the characteristics of the Atypical category?
Atypical:
- Headache lasting longer than 72 hours
- Ischemic infarction may be found on neuroimaging
- Neuro manifestations persist for 7 days
- Do not fit other criteria (unclassified)
Migraine (Patient Education):
What is the migraine “Three R” approach with a patient?
Migraine (Patient Education):
“Three R” approach:
“R”ecognize migraine symptoms
“R”espond and seek health care provider
“R”elieve pain and associated symptoms
What are nursing care considerations during a headache?
Nursing care during a headache:
- Maintain a cool, dark, quiet environment
- Elevate HOB to 30 degrees
- Administer medications as prescribed
Abortive Therapy:
What are the abortive therapy medications to alleviate MILD migraine pain?
Abortive Therapy:
- Acetaminophen
- NSAIDs (Ibuprofen, naproxen)
- OTC anti-inflammatory (Advil Migraine Capsules)
- Antiemetics to relive N/V: metoclopramide (Reglan)
Abortive Therapy:
What are the abortive therapy medications to alleviate SEVERE migraine pain?
Abortive therapy:
- Triptan preparations
- Ergotamine preparations
- Isometheptine combination
Abortive Therapy:
How do the Triptan preparations work against SEVERE migraines?
Abortive therapy: Severe migraine
Triptan preparations produce a vasoconstrictive effect.
zolmitriptan, sumatriptan, eletriptan
Abortive Therapy:
How do the Ergotamine preparations preparations work against SEVERE migraines?
Abortive therapy: Severe migraine
Ergotamine preparations with caffeine narrow blood vessels and reduce inflammation.
-Cafergot, dihydroergotamine (Migranal)
Abortive Therapy:
When is the Isometheptene combination formulations against SEVERE migraines used?
Abortive Therapy: Severe migraine
Isometheptine in combination formulations (Midrin) used when other medications DO NOT WORK.
Preventative Therapy:
What are the preventative medications given for frequent headaches or when other therapies are ineffective?
What is important to instruct patients to do with these medications?
Preventative Therapy:
- NSAIDs with: (Drugs below)
- Beta blocker: Propranolol, timolol,
- Calcium channel blocker: verapamil
- Antiepileptic drugs: Topiramate, divalproex (Depkote)
***Instruct patient to check pulses when taking beta-adrenergic blockers and calcium channel blockers.
Preventative Therapy:
What are some foods with tyramine to avoid?
What else should be avoided?
Preventative Therapy:
- Avoid foods with tyramine (nuts, pickles, caffeine, beer, wine, aged cheese, artificial sweeteners, sugar-free beverages)
- Avoid foods with MSG or preservatives
Preventative Therapy:
What medications are known to induce migraines?
Medications known to induce migraines:
ranitidine, estrogen, nitroglycerine, nifedipine
What are cluster headaches?
How long do they last?
How often do they occur?
Do they radiate?
Are there warning signs?
Are they seasonal?
-Cluster headaches are brief episodes of intense, unilateral non-throbbing or boring pain. (trigeminal autonomic cephalalgia)
- Lasting 30 minutes to 2 hours
- Occurring daily at about the SAME TIME for 4 to 12 weeks
- Yes, can radiate to forehead, temple, or cheek.
- No warning signs
- Yes, cluster headaches are more frequent during the fall and spring.
What is the patho of cluster headaches?
Cluster headache Patho:
Vasoreactivity and Neurogenic inflammation
What are symptoms of cluster headaches?
Cluster headache Symptoms:
- Tearing of eye with nasal congestion
- Facial sweating
- Drooping eyelid (ptosis) and eyelid edema
- Miosis
- Facial pallor –> Very white
- Nausea & vomiting
- Pacing, walking, and rocking activities
What are the medication treatments used for cluster headaches?
Cluster headache: Mediation treatments:
- Triptans
- Ergotamine preparations
- Antiepileptic medications
- CCC, Lithium, Corticosteroids
- Melatonin, Glucosamine
- OTC Capsaicin
What should be taught for the oxygen therapy used for cluster headaches?
Oxygen therapy:
- 100% for short periods of time during headache, the d/c
- Remain in sitting position when using oxygen, and maintain safety precautions when using at home.
What are some strategies to prevent cluster headaches?
- Wear sunglasses
- Obtain adequate rest, exercise, relaxation
- Avoid tyramine MSG, nitrates (preservatives)
What are the risk factor (triggers) for cluster headaches?
Cluster Headache Risk factors:
- Anger outburst
- Stress
- Excessive physical activity
- Altered sleep-wake cycles
