Unit 1: Headaches Flashcards
Week 1
Headache
“cephalgia”
- primary or secondary
- most common clinical manifestation of pain
- result of the reaction of nociceptors (pain-sensitive nerve endings) to triggers, sending messages to the thalamus via he trigeminal nerve (CN V)
- can influence the performance of ADLs
What is pain related to?
r/t a reaction by the nociceptors (pain-sensitive nerve endings) to triggers sending messages to the thalamus
Primary Headaches
- not associated with other underlying disease or organic causes
- tension headaches (muscular)
- migraine headaches (vascular)
- cluster headaches (neurological)
Secondary Headaches
- caused by an underlying structural problem (stroke, tumor, meningitis, or encephalitis); have a direct cause
- sudden onset of severe pain
- causes: sinuses, ear, nose, mouth, cervicogenic (joints, muscles, vertebrae), referred pain from trigger points in neck, shoulders, and upper back
Primary Headache: Tension Headache
- episodic or chronic
- constant pressure pain
- sensitivity to light
- mild to moderate pain that is bilateral
- pts describe pain as constant pressure to the face, head, and neck; w/ sensitivity to light
- scalp soreness
Tension Headaches: Episodic
- occur 10 to 15 days per month
- lasting 30 minutes to several days
- causes: jaw clenching, temporomandibular joint dysfunction, degenerative arthritis of the neck, forceful/intense
- common location: frontal and temporal, bilateral, occipital
- tension causes headache
Tension Headaches: Chronic
- occur more than 15 days per month during a 3 month period
- more severe than episodic
- causes: work or exercise, poor posture, lack of sleep, sleep apnea, missed meals, depression, anxiety
- pain mild to moderate
- constant pressure to face, head, and/or neck
- sensitivity to light
- scalp soreness
- morning headaches when lack of sleep and/or sleep apnea involved
- forceful/intense
Primary Headache: Migraine Headaches
- 4 phases: premonitory phase, aura, headache phase, and postdromal phase
- occur most frequently in the morning (upon awakening); predictable times (menstruation)
- pulsating, throbbing
- can have double vision (diplopia) or seeing spots (floaters)
- mood changes, fluid retention, increased urinary output, excessive uncontrolled yawning, food cravings, aura, confusion, exhaustion
Migraine Headaches: 4 Phases
- Premonitory phase: can occur 24 hours before headache develops; mood changes, fluid retention, increased urine output, excessive uncontrolled yawning, and food cravings
- Aura: just prior to the migraine, may experience particular sensations (auras); flashing lights and muscle weakness
- Headache Phase: pain starts gradually, building in intensity; some have a migraine w/o headache pain
4: Postdromal Phase: confusion and exhaustion; last for 24 hours before pt feels they are back to their baseline health
Migraine Headaches: Triggers
- changes in weather
- changes in environment
- strong odors/fumes
- tobacco
- motion sickness
- hormonal changes
- hypoglycemia
- flashing lights
- lack of sleep
- stress
Migraine Headaches: Food Triggers
- aspartame
- wine
- aged cheeses
- monosodium glutamate (MSG)
- caffeine
- caffeine withdrawal
- fruits
- nuts
- fermented and pickled foods
- yeast
- processed foods
Primary Headaches: Cluster Headache
“neurovascular headache”
- most severe
- severe, unrelenting, unilateral pain in and around the eye
- peak pain: within 5 to 10 minutes after onset; continuing in intensity for 1 to 3 hours
- occur around the same time for several weeks
- more often at night
- recur daily for weeks to months followed by periods of remission
- agitation and restlessness
Diagnosis of Headaches
- HX and physical
- Blood Tests
- Lumbar Puncture
- CT
- MRI
- depends on time course of headache occurrence
- review of the headache diary (medical Hx)
- neurological assessment
- to help r/o secondary causes
Patients with sudden onset of headache are evaluated for clinical manifestations of?
- meningitis
- cerebrospinal fluid (CSF) leak (pts who have had a lumbar puncture or epidural catheter removal)
- cerebral aneurysm
- cerebral aneurysm rupture
- or brain tumor
Headache Diary
- part of the medical Hx
- to track, characterize headache symptoms over a period of time
- record time, date, activities, foods, and medications
Diagnostic Tests: Blood Tests
- to assess for infection (CBC, cultures)
- assess for inflammation (C-reactive protein, erythrocyte sedimentation rate)
Diagnostic Test: CT/ MRI
to r/o masses, cysts, aneurysms, and irregularities in the vessels or bones of the head
Diagnostic Test: Lumbar Puncture
CSF obtained to measure pressure (high or low pressures can cause headaches), signs of infection, and inflammation
Diagnostic Test: Electroencephalogram (EEG)
measures the electrical activity in the brain
-assist in diagnosis of seizures, tumors, inflammation, and brain injury, which can all lead to headaches
Diagnostic Tests: Sleep Studies
to diagnose sleep apnea if a hx of obesity, snoring, or fatigue is present
Medical Management
- treat underlying cause
- anti-inflammatory medications
- analgesics
- muscles relaxants
- sedatives
- antidepressants
- abortive therapy (cluster headaches)
Treatment
- treat underlying disorders or diseases
- depression and anxiety can cause tension headaches; counseling and antianxiety and antidepressants can aid in relief
- headaches r/t poor posture relieved w/ physical therapy
- headaches r/t arthritis relieved w/ anti-inflammatory medications
- tension headaches r/t temporomandibular joint dysfunction relieved w/ corrective devices
Medications
- NSAIDs, Analgesics, Muscle Relaxants, Sedatives, and Anti-depressants help in alleviating pain in tension and migraine headaches
- Migraines: medications used to relieve the immediate clinical symptoms of the migraine (abortive therapy), and those designed to prevent the migraine
- Anti-inflammatories can reduce inflammation and ease pain of migraines
- Combination of acetaminophen w/ caffeine can alleviate symptoms of migraines
- Calcium Channel Blockers to prevent migraine headaches
Complications
- Medication Overuse
- Status Migrainosus
Complications: Medication Overuse Headaches
- develop chronic daily headaches as a result of excessive use of OTC medications (acetaminophen, ibuprofen)
- daily or near daily use of OTC medications begins a cycle resulting in frequent headaches that cannot be broken unless the medications are stopped
- Treatment: sudden withdrawal of the medications while the provider places the patient on medication to prevent headaches; or more gradual withdrawal from OTC medication
Complications: Status Migrainosus and Hemicrania continua
Continuous headache syndromes are debilitating disorders
- unable to experience headache relief; treated on inpatient basis
- Treatment: IV hydration; pharmacological tx w/ dihydroergotamine and antiemetics (Ondansetron)
Nursing Management: Assessment and Analysis
-Clinical presentation depends on etiology and pattern of manifestations
>Complains of:
-acute head pain
-photophobia (sensitivity to light)
-nausea
-vertigo
-aura (particular sensations; flashing lights + muscle weakness)
Nursing Diagnoses
- Acute pain r/t neurovascular dysfunction (vasodilation of cerebral vessels)
- Knowledge deficit r/t concealment of triggers initiating migraine headache
- Self-care deficit r/t inability to manage the headaches
Nursing Assessments
- Vital Signs
- Pain
- Triggers
- Abortive or Preventative Measures
- Auras
Nursing Assessments: Vital Signs
- pain stimulates the autonomic nervous system
- increased in heart rate, blood pressure, and respiratory rate
Nursing Assessments: Pain
- detailed pain assessment
- helps differentiating type of headache
- provides important data r/t relief measures and pain medication
Nursing Assessments: Triggers
- identifying and managing triggers to headaches
- helps in decreasing the frequency and severity of headaches
Nursing Assessments: Abortive and Preventative Measures
- patient identification and management of symptoms at onset; help alleviate severity of headache and abort headache
- Abortive Medications: Sumatriptan, dihydroergotamine
Sumatriptan (Imitrex)
“triptans” for migraines
- abortive medication
- increases serotonin causing vasoconstriction and lowers pain threshold
Dihydroergotamine
- binds to the serotonin receptors on the nerve endings, decreasing transmission of pain messages along the nerve fibers
- decreases pain signals to nerves
- effective during early stages of migraines
Nursing Assessments: Auras
-if experience an aura in advance of the headache, abortive interventions may be implemented earlier to decrease the severity of the headache
Nursing Actions
- Administer prescribed medications
- Maintain calm, dark, quiet environment
Nursing Actions: Administer prescribed medications
- NSAIDs prescribed for their anti-inflammatory properties
- Caffeine derivatives block adenosine; lead to vasoconstriction of blood vessels
- Antiemetics indicated for nausea and vomiting
Nursing Actions: Maintain calm, dark, quiet environment
excessive noise and lights may trigger and exacerbate pain symptoms by stimulating the sympathetic nervous system (“fight or flight”)
Nursing Teaching
- Adequate sleep
- Take medications as prescribed
- Food Triggers
Nursing Teaching: Importance of Adequate Sleep
sleep and rest are associated with a decrease in headaches associated w/ stress
Nursing Teaching: Take pain medications as prescribed
severity of headaches may be better controlled with a timely and appropriate medication regimen
Nursing Teaching: Food Triggers
identifying food triggers and eliminating them from the diet can reduce and prevent migraine headaches
Evaluation of Headaches
- headaches can become a chronic debilitating disorder
- management of headaches requires proper diagnosis and management
- once pt is familiar with the personal headache hx, headache triggers, and best approaches to pain control, episodes of headache are better managed
- use of certain nutritional supplements (Riboflavin (vitamin B), magnesium, and coenzyme Q10), biofeedback, meditation, yoga, and acupressure may help
- lifestyle changes
Calcium Channel Blockers
- to prevent migraines
- thought to prevent vasoconstriction or vasodilation in cerebral blood vessels
Anti-convulsant Medications Used
-Lamotrigine (Lamictal)
-Gabapentin (Neurontin)
>increase levels of neurotransmitters and diminish pain impulses
-used for seizure disorders
