TOPIC 11 - neuro part 2 Flashcards
types of headaches
primary
tension
migraine
cluster
secondary
primary vs secondary headaches
primary are not caused by disease or another medical condition (ex: tension, migraine, cluster)
secondary are caused by another condition or disorder (ex: sinus infection, neck injury, brain tumor)
pain location of tension headaches
Tension headache is often described as a feeling of a weight in or on the head and/or a band squeezing the head.
pain location of migraine headaches
Migraine headache is described as an intense, throbbing or pounding pain that involves one temple. The pain usually is unilateral (on one side of the head), although it can be bilateral.
pain location of cluster headaches
Cluster headache pain is focused in and around one eye and is often described as sharp, penetrating, or burning.
tension headaches
most common
bilateral location : pressing/tightening quality
mild or moderate
episodic or chronic
bilateral frontal-occipital : contant, dull, bandlike
NO warning symptoms, NO nausea or vomiting, NO trouble with physical activity
SENSITIVITY to light or sound
migraine headaches
unilateral throbbing pain, premonitory symptoms or triggers, onset between 20-30, affects more females than males, state of neuronal hyper-excitability in occipital cortex of the cerebral cortex, may or may not have known precipitating factors
what medical issues are migraine headaches associated with
seizure disorders, ischemic stroke, asthma, depression, anxiety, myocardial infarction, Raynaud’s syndrome, and irritable bowel syndrome.
precipitating factors for migraine headaches
include foods, menstruation, head trauma, physical exertion, fatigue, stress, missed meals, weather, and drugs. Food triggers include chocolate, cheese, oranges, tomatoes, onions, monosodium glutamate, aspartame, and alcohol (particularly red wine).
risk factors for migraine headaches
Family history
Low level of education
Low socioeconomic status
High workload
Frequent tension-type headaches
clinical manifestations of migraine headaches
neurologic, psychologic, or other premonitory manifestations
aura
steady, throbbing
synchronous with pulse
may last 4-72 hrs
vary in severity
cluster headaches
generally occur at same time of day or night
onset between 20-45
men more affected
what is the most common type of headache
tension
what is the most severe primary headache
cluster
triggers for cluster headaches
alcohol
strong odor
weather changes
what part of the brain is affected in cluster headaches
ophthalmic branch of trigeminal nerve
hypothalmus
irregularities with melatonin and cortisol
manifestations of cluster headaches
Sharp, stabbing, intense pain lasts minutes to 3 hours
May occur every other day and as often as 8x/day
Can occur in cycles with remission periods in between
Pain is generally located around the eye, radiating to the temple, forehead, cheek, nose, or gums
Swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and miosis (constriction of the pupil).
often agitated and restless, unable to sit still or relax
aura similar to migraine may occur in 14% of patients up to 60 minutes before an attack.
Cluster headaches can occur every other day and as often as eight times a day.
Because cluster periods often occur seasonally, headaches may be mistaken for symptoms of allergies.
health history for assessment of headaches
Seizures, cancer, stroke, trauma, asthma or allergies, mental illness, stress, menstruation, exercise, food, bright lights, noxious stimuli
Medications
Surgery and other treatments
objective data for assessment of headaches
Anxiety or apprehension
Diaphoresis, pallor, unilateral flushing with cheek edema, conjunctivitis
details about the headache in assessment
Location, Type of pain
Onset, Frequency, Duration, time of day
Relation to outside events
if no systemic underlying disease is the cause of the headache, what guides therapy
the type of headaches
types of therapies: Drugs, medications, yoga, biofeedback, cognitive-behavioral therapy, and relaxation training
symptomatic drug therapy for tension headaches
Mild-moderate headache treated with aspirin, acetaminophen, or an NSAID alone or in combination with a sedative, muscle relaxant, or tranquilizer
preventative drug therapy for tension headaches
Tricyclic antidepressants
Antiseizure medications
preventative drug therapy for migraine headaches
Antiseizure drugs - GABA, topiramate
Botox
SSRIs
symptomatic drug therapy for migraine headachces
Mild to moderate headache can obtain relief with NSAID, aspirin, or caffeine-containing combination analgesics
skin patch for migraine headaches
zecuity
first line therapy for moderate to severe headaches
triptans
- vasoconstrict : caution to pt with heart disease or stroke
preventative drug therapy for cluster headaches
High-dose verapamil
Varied other options : lithium, ergotamine, antiseizure drugs (e.g., topiramate), and melatonin.
Invasive nerve blocks, deep brain stimulation, and ablative neurosurgical procedures have been used for refractory cluster headaches
symptomatic drug therapy for cluster headaches
triptans (dont give to pt with vascular risk factors)
100% oxygen at 6-8 L/min for 10 min non rebreather (repeat after 5 min rest)
headache nursing implementation
Teach patient about preventive treatment
Dietary counseling for food triggers
Avoid smoking and other environmental triggers
An inability to cope with daily stresses can cause headaches
Daily exercise, relaxation periods, and socializing help reduce recurrence and should be encouraged
Suggest alternative pain management such as relaxation, meditation, yoga, and self-hypnosis
Encourage a quiet, dim environment
Massage and heat packs can help with tension-type
Patient should make a written note of medications to prevent accidental overdose
