Headaches

Headaches

1. Migraines

   • Triggers: Caffeine, Red Wine, Stress, Change in weather
   • Three categories: With aura, Without aura, and Atypical
     • What is an aura? Sensation such as visual changes that signals the onset of a headache or seizure *Most headaches are migraines without aura *Atypical migraines-less common & are menstrual and cluster migraines
     • Occurrence w/o aura: Episodic, Lasts 4-72 hours
     • Occurrence atypical: lasts more than 72 hours
   • Symptoms: Unilateral, Intense stabbing pain, worse with movement, N/V, photophobia/phenophobia
     • What is photophobia? light sensitivity  What is phonophobia? sound sensitivity 
   • Treatment: Abortive therapy, Medication, CAM
     • Treatment: 1.) Abortive therapy: Stop the pain at the aura phase 2.) Medication (Mild) 3.) Medication (Severe) CAM therapies- yoga, meditation, relaxation, massage, exercise, acupuncture
     • MILD Meds
       • Acetaminophen
       • NSAIDS
       • Antiemetics for N/V
       • Reglan
         • Administered with NSAIDS to promote gastric emptying and decrease vomiting  -Increases motility in gut
     • SEVERE Meds
       • Triptan
         • -relieves headache and symptoms by activating receptors on the cranial arteries  -Given nasal, PO, & IM -Does not go well with SSRI's; overdose of SSRI and then issues in the brain -Also does not go well with St. John's Wart 
         • Zomig
         • Imitrex
         • Patient teaching/Safety
           • -Take triptan as soon as migraine develop -report angina to prevent damage or myocardial ischemia -Use cntraception -common side effects: flushing, tingling
     • Other drugs: calcium channel blockers, antiepileptic, beta blockers
       • Pt teaching for cardiac drugs: check pulse and report bradycardia or fatigue and SOB

2. Clusters

   • Triggers: Stress, Alcohol, Relaxation, Napping, REM sleep
   • Occurrence: 30 mins - 2 hours, unilateral pain; CHRONIC
     • -Reoccurs every few weeks -Brief periods of pain during the same time (mornings ex.)
   • Symptoms: Excrutiating, nonthrobbing, rhinorrhea, ptosis, facial edema
   • Treatment: Meds, O2, Surgery, CAM
     • *Same drugs for migraines: Triptans, Calcium channel blockers, antiepleptics -Lithium and corticosteroids -O2-15-20 mins (high flow mask) -Surgery-Trigenimal nerve

3. Assessment: r/o Tumors, anuerism, high BP

   • Assessment of Headaches:  1.) rule out anything else 2.) Pain assessment-0-10, PQRST 3.) Get History & Physical 4.) Clusters or Migraines?