Tension

Migraine

Cluster

Causes are not fully understood.

Migraines are inherited though.

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).

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

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.

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.

May be a varient of migraines.

Mechanism not fully understood but abnormal activity in hypothalamus.

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

No family history.

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".

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

Nasal congestion & rhinorrhea on affected side.  Flushed face.

Causes pt to pace & thrash about.

History.

CT, MRI to r/o other disorders.

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.

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.

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.

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.

Analgesics

 Triptans

Ergots

Antiemetics

Prophylactics

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

-Imitrex: mimics serotonin

(similar drugs: maxalt, amerge, zomig)

Constrict vessels in outer brain & scalp.

Ergotamine, DHE 45

May cause MI in angina pts.

Reglan, compazine.

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

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.

Most common type of HA (90%)

New name is "tension-type"

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

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

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

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

Mild analgesic (Tylenol, ASA, NSAID)

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

Stress reduction.

Remove triggers.

Rest, sleep, regular exercise.

New glasses.

Treat sinusitis.

Acupuncture

Massage

Aroma therapy

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

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.