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med surg Unit 7 Neuro
Headaches
37
Nursing
Undergraduate 1
03/14/2011

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Cards

Term
Another name for headache?
Definition
Cephalalgia
Term
What is a Headache (cephalalgia)?
Definition
May be a symptom accompanying other disorders (meningitis, increased ICP, brain tumor, sinusitis) or may be a primary disorder.
Term
What are the 3 catagories of Headaches?
Definition

Tension

Migraine

Cluster

Term
When do Migraines typically begin?
Definition
Typically in childhood, adolescence, or early adulthood & improve with age.
Term
Who is more prone to Migraines?
Definition
Females > Males
Term
What causes Migraines?
Definition

Causes are not fully understood.

Migraines are inherited though.

Term
What are Migraine triggers?
Definition

Stress, fatigue, lack of sleep, too much sleep, excess CHO intake, iodine rich foods, ETOH, aged cheese, MSG, aspartame, caffeine, fermented/marinated/pickled foods, chocolate, chemical additives, allergies, tobacco & smoke.

 

BAROMETRIC PRESSURE, SEASONS, time zone or altitude changes, bright lights, sun glare, intense exercise.

 

Estrogen levels, odors, hypoglycemia, meds (tagamet, theodur, pondamine, procardia).

 

Term
Pathological changes that occur with Migraines?
Definition

Spasms in arteries in the scalp and neck occurs - Platlets in arteries become trapped in narrowed passages - Serotonin released - Blood flow altered -

Accessory arteries dilate widely - Neurochemicals released - Nociceptors stimulated - Headache

 

Term
Clinical manifestations of Migraines?
Definition

10-30 min before: Aura (10%)- Sparkling flashes of light. Dazzling zig-zag lines, wavvy lines. Dizziness, blind spots. Numbness & tingling, or weakness in face, hands, or legs. Difficulty seeing or hearing.

 

Several hours before: Feelings of elation or intense energy. Cravings for sweets, thirst. Difficulty concentrating. Drowsiness, unusual fatigue. Irritability or depression.

 

Term
Pain associated with Migraines?
Definition

Often severe and disabling.

Usually lasts 4-72 hours.

Throbbing or bursting, usually starts on one side but can spread to entire head.

Accompanied by N/V, puffy face, irritability, fatigue.

 

Term
What is a Cluster Headache?
Definition

May be a varient of migraines.

 

Term
What causes a Cluster Headache?
Definition

Mechanism not fully understood but abnormal activity in hypothalamus.

Triggered by ALCOHOL, vasodilating agent (ie. nitro, may be seasonal).

 

No family history.

 

Term
Who is more prone to Cluster Headaches?
Definition
Males > Females
Term
When do Cluster Migraines begin?
Definition
Onset adolescence or early 20's.
Term
Pain (clinical manifestation) associated with Cluster Headaches?
Definition

Pain: Rapid onset- intensifies w/in 15 min & lasts up to 3 hrs. Usually starts 2-3 hrs after falling asleep, during REM. Attacks are frequent (multiple times day/week/month/yr), then possible remission for yrs.

 

Behind, in or around eye or in temple, cheek or jaw on affected side (trigeminal nerve area).

 

One side of head, may radiate.

Intense burning, boring "like a hot poker".

Term
Clinical manifestations (other than pain) of Cluster Headaches?
Definition

Red eye, tearing, constricted pupil & ptosis on affected side. 

Nasal congestion & rhinorrhea on affected side.  Flushed face.

Causes pt to pace & thrash about.

Term
How to diagnose Cluster Headaches?
Definition

History.

CT, MRI to r/o other disorders.

Term
Collaborative management of Cluster Headaches?
Definition

100% oxygen to reduce vasodilating compensatory response in the brain.

Ergots, Ca channel blockers, lithium, steroids, imitrex, neurontin.

 

Surgery or radiation- trigeminal nerve but causes permanent sensory/motor dysfunction.

 

Rhizotomy- sectioning of spinal nerve before it enters the cord.

Term
What is a Rhizotomy?
Definition
Sectioning of spinal nerve before it enters the cord.
Term
Nursing considerations for Cluster Headaches?
Definition

Administer, teach about & monitor effects of medications.

LYING DOWN & SLEEP MAY AGGRAVATE.

Avoid noise during episode.

Keep HA journal to help ID triggering & aggravating factors.

Teach when to seek help.

Term
When to seek help with any HA?
Definition

Abrupt, severe HA, often like a thunderclap.

 

HA with fever, stiffneck, rash, confusion, seizures, double vision, weakness, numbness, or speaking difficulties.

 

HA after a head injury, even if its a minor fall or bump (esp. if it gets worse or if pt is on anticoags).

 

Chronic, progressive HA that worsens after coughing, exertion, straining, or a sudden movement.

 

New onset HA pain after age 40.

Term
How to diagnose a Migraine Headache?
Definition

CT, MRI, brain scan, skull & sinus x-rays, cerebral angios, spinal tap - to r/o other disorders.

Vision tests.

GI work-up r/t nausea & vomitting.

Term
Types of medications to treat Migraine Headaches?
Definition

Analgesics

 Triptans

Ergots

Antiemetics

Prophylactics

Term
Triptans for Migraine Headaches?
Definition

PO, nasal, SQ (expensive, only works 5hrs, may cause MI, CVA or bowel ischemia).

-Imitrex: mimics serotonin

(similar drugs: maxalt, amerge, zomig)

Term
Analgesics to treat Migraine Headaches?
Definition
NSAID's, non-opioids (tylenol, ASA), narcotics (codeine, Demerol)- mild analgesics are usually in effective.
Term
Ergots to treat Migraine Headaches?
Definition

Constrict vessels in outer brain & scalp.

Ergotamine, DHE 45

May cause MI in angina pts.

Term
Antiemetics to treat Migraine Headaches?
Definition

Reglan, compazine.

 

Term
Prophylactics to treat Migraine Headaches?
Definition

Prophylactic meds can decrease the frequency & severity of attacks & increase effectiveness of abortive medications.

 

Beta blockers & Ca blockers: prevent dilatation & spasms

Antidepressants: Elavil, pamelor

Anticonvulsants: Valproic acid, neurontin

Periactin: antihistamine which affects serotonin

Term
Nursing considerations for Migraine Headaches?
Definition

Administer, teach about & monitor effects of drugs.

Teach to use drugs as soon as s/s begin.

HA journal to help id & eliminate triggers & aggravating factors.

 

Provide & teach: Rest/sleep enough, but not too much. Lie in bed in a dark room. Minimize noise & stimuli. When to seek help.

 

Biofeedback, relaxation, regular exercise.

Smoking cessation.

 

Term
Tension Headache?
Definition

Most common type of HA (90%)

New name is "tension-type"

Term
Causes of Tension Headaches?
Definition

Contraction or strain of neck, head or eye muscles r/t:

Emotional stress

Eye strain

Fatigue

Sexual activity

Maintaining on position for long periods of time

Term
Clinical manifestations of Tension Headaches?
Definition

Mild ache to severe disabling pain

Pain diffuse & "like a tight band aroung head"

Pain in back of neck at base of skull

Difficulty sleeping

Lasts 30 mins to 1 week

May be occassional, frequent or chronic

Term
Diagnosis of Tension Headaches?
Definition

CT scan, MRI, head & neck x-rays, angiograms.

*r/o brain tumor, intracerebral bleed, TMJ and sinus infection

Term
Medication management of Tension Headaches?
Definition

Mild analgesic (Tylenol, ASA, NSAID)

 

Elavil- helps 65% even if not depressed (affects nerve cells)

Term
Non-medication treatment for Tension Headaches?
Definition

Stress reduction.

Remove triggers.

Rest, sleep, regular exercise.

New glasses.

Treat sinusitis.

 

 

Term
Alternative therapies for Tension Headaches?
Definition

Acupuncture

Massage

Aroma therapy

 

Smell or massage with salve made of: ginger, peppermint, wintergreen oil.

Term
Pain assessment for Tension Headaches?
Definition

Location: one area or entire head.

Type of pain, whether same as past HA.

Aggravating/relieving factors.

Duration, frequency.

Accompanying s/s: tearing, N/V, nasal congestion.

Allergies, vital signs, neuro signs.

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