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Nursing 272: Final Semester > Unit 1: Headaches > Flashcards

Unit 1: Headaches Flashcards

Week 1

1
Q

Headache

A

“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
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2
Q

What is pain related to?

A

r/t a reaction by the nociceptors (pain-sensitive nerve endings) to triggers sending messages to the thalamus

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3
Q

Primary Headaches

A
  • not associated with other underlying disease or organic causes
  • tension headaches (muscular)
  • migraine headaches (vascular)
  • cluster headaches (neurological)
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4
Q

Secondary Headaches

A
  • 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
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5
Q

Primary Headache: Tension Headache

A
  • 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
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6
Q

Tension Headaches: Episodic

A
  • 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
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7
Q

Tension Headaches: Chronic

A
  • 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
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8
Q

Primary Headache: Migraine Headaches

A
  • 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
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9
Q

Migraine Headaches: 4 Phases

A
  1. Premonitory phase: can occur 24 hours before headache develops; mood changes, fluid retention, increased urine output, excessive uncontrolled yawning, and food cravings
  2. Aura: just prior to the migraine, may experience particular sensations (auras); flashing lights and muscle weakness
  3. 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
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10
Q

Migraine Headaches: Triggers

A
  • changes in weather
  • changes in environment
  • strong odors/fumes
  • tobacco
  • motion sickness
  • hormonal changes
  • hypoglycemia
  • flashing lights
  • lack of sleep
  • stress
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11
Q

Migraine Headaches: Food Triggers

A
  • aspartame
  • wine
  • aged cheeses
  • monosodium glutamate (MSG)
  • caffeine
  • caffeine withdrawal
  • fruits
  • nuts
  • fermented and pickled foods
  • yeast
  • processed foods
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12
Q

Primary Headaches: Cluster Headache

A

“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
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13
Q

Diagnosis of Headaches

A
  • 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
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14
Q

Patients with sudden onset of headache are evaluated for clinical manifestations of?

A
  • meningitis
  • cerebrospinal fluid (CSF) leak (pts who have had a lumbar puncture or epidural catheter removal)
  • cerebral aneurysm
  • cerebral aneurysm rupture
  • or brain tumor
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15
Q

Headache Diary

A
  • part of the medical Hx
  • to track, characterize headache symptoms over a period of time
  • record time, date, activities, foods, and medications
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16
Q

Diagnostic Tests: Blood Tests

A
  • to assess for infection (CBC, cultures)

- assess for inflammation (C-reactive protein, erythrocyte sedimentation rate)

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17
Q

Diagnostic Test: CT/ MRI

A

to r/o masses, cysts, aneurysms, and irregularities in the vessels or bones of the head

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18
Q

Diagnostic Test: Lumbar Puncture

A

CSF obtained to measure pressure (high or low pressures can cause headaches), signs of infection, and inflammation

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19
Q

Diagnostic Test: Electroencephalogram (EEG)

A

measures the electrical activity in the brain

-assist in diagnosis of seizures, tumors, inflammation, and brain injury, which can all lead to headaches

20
Q

Diagnostic Tests: Sleep Studies

A

to diagnose sleep apnea if a hx of obesity, snoring, or fatigue is present

21
Q

Medical Management

A
  • treat underlying cause
  • anti-inflammatory medications
  • analgesics
  • muscles relaxants
  • sedatives
  • antidepressants
  • abortive therapy (cluster headaches)
22
Q

Treatment

A
  • 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
23
Q

Medications

A
  • 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
24
Q

Complications

A
  • Medication Overuse

- Status Migrainosus

25
Q

Complications: Medication Overuse Headaches

A
  • 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
26
Q

Complications: Status Migrainosus and Hemicrania continua

A

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)
27
Q

Nursing Management: Assessment and Analysis

A

-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)

28
Q

Nursing Diagnoses

A
  • 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
29
Q

Nursing Assessments

A
  • Vital Signs
  • Pain
  • Triggers
  • Abortive or Preventative Measures
  • Auras
30
Q

Nursing Assessments: Vital Signs

A
  • pain stimulates the autonomic nervous system

- increased in heart rate, blood pressure, and respiratory rate

31
Q

Nursing Assessments: Pain

A
  • detailed pain assessment
  • helps differentiating type of headache
  • provides important data r/t relief measures and pain medication
32
Q

Nursing Assessments: Triggers

A
  • identifying and managing triggers to headaches

- helps in decreasing the frequency and severity of headaches

33
Q

Nursing Assessments: Abortive and Preventative Measures

A
  • patient identification and management of symptoms at onset; help alleviate severity of headache and abort headache
  • Abortive Medications: Sumatriptan, dihydroergotamine
34
Q

Sumatriptan (Imitrex)

A

“triptans” for migraines

  • abortive medication
  • increases serotonin causing vasoconstriction and lowers pain threshold
35
Q

Dihydroergotamine

A
  • 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
36
Q

Nursing Assessments: Auras

A

-if experience an aura in advance of the headache, abortive interventions may be implemented earlier to decrease the severity of the headache

37
Q

Nursing Actions

A
  • Administer prescribed medications

- Maintain calm, dark, quiet environment

38
Q

Nursing Actions: Administer prescribed medications

A
  • NSAIDs prescribed for their anti-inflammatory properties
  • Caffeine derivatives block adenosine; lead to vasoconstriction of blood vessels
  • Antiemetics indicated for nausea and vomiting
39
Q

Nursing Actions: Maintain calm, dark, quiet environment

A

excessive noise and lights may trigger and exacerbate pain symptoms by stimulating the sympathetic nervous system (“fight or flight”)

40
Q

Nursing Teaching

A
  • Adequate sleep
  • Take medications as prescribed
  • Food Triggers
41
Q

Nursing Teaching: Importance of Adequate Sleep

A

sleep and rest are associated with a decrease in headaches associated w/ stress

42
Q

Nursing Teaching: Take pain medications as prescribed

A

severity of headaches may be better controlled with a timely and appropriate medication regimen

43
Q

Nursing Teaching: Food Triggers

A

identifying food triggers and eliminating them from the diet can reduce and prevent migraine headaches

44
Q

Evaluation of Headaches

A
  • 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
45
Q

Calcium Channel Blockers

A
  • to prevent migraines

- thought to prevent vasoconstriction or vasodilation in cerebral blood vessels

46
Q

Anti-convulsant Medications Used

A

-Lamotrigine (Lamictal)
-Gabapentin (Neurontin)
>increase levels of neurotransmitters and diminish pain impulses
-used for seizure disorders

Nursing 272: Final Semester (79 decks)

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