Module 20.1; Headaches

Nursing 3410 with Baldree at East Carolina University

About this deck

By: John Berger
Textbook:

Understanding Pathophysiology
Created: 2011-02-20
Size: 20 flashcards
Views: 16

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Who gets headaches?

Women > Men

Primary Headaches

idiopathic
Migraines
Tension-type
Cluster & other trigeminal autonomic cephalagias
other primary headaches:

stabbing
cough
exertional
assoc. w/ sexual activity

Secondary headaches assoc with....

head or neck trauma
cranial or cervical vascular disorders
substance use or other withdrawal
infection
bleeding
disorders of cranial, facial, or sensory organ structures (HEENT, teeth, mouth)
Psychiatric disorders

3 most common types of headaches

#1 - Tension type (TTH) - (muscle contracture) No genetic ties
#2 - Migraine - Runs in families
#3 - Cluster - occurs most often in men

Other types of headaches

caffeine withdrawal
hunger
menstrual
alcoholic hangover
eyestrain
sinus
brain freeze
TMJ
rebound
post-traumatic

Diagnosis or headaches

Careful, careful comprehensive history & physical to r/o secondary causes
OPQRST
ameliorative factors
assoc. sx
neurologic accompaniments
med history
family history
life-style and social history
ROS

Tension (muscle contracture) headache

Onset in adolescence or young adulthood
non-familial
pain typically bilateral, bifrontal, bitemporal, or suboccipital
pain described as "band like" or sensation of non-pulsating pressure
Not aggravated by routine physical activity
NO nausea/vomiting

Tension cont'd.......

NO lacrimation or rhinorhea
more frequent in afternoon or evening
Duration : 30 min-hours
Precipitated by stress, depression, or anxiety
incidence increases with education level
Increased pericranial tenderness recorded my manual palpation
pericranial tenderness increases w/ intensity/freq of headaches
tenderness increases progressively during the individual headache episode.

Migraine Headaches

Form of vascular HA
onset in childhood, adolescence, or early adulthood (peak prevalence= 35-45)
women > men (estrogen aggravation)
runs in families- autosomal dominance w/ incomplete penetrance (>70% have + FH)
Usually unilateral, throbbing or pulsatile

Migraines cont'd.......

Nausea/vomiting common
Scintillations- bright zigzag lines
Scotoma- blind spots
Duration- several hours to days
Triggers: MSG, aged cheese, chocolate, red wine

Migraine w/o aura

Pulsatile, throbbing, unilateral HA
Lasts 1-2 days
Aggravated by physical activity
nausea/vomiting
disabling
sensitivity to light, sound
visual disturbances- stars, sparks, light flashes

Migraine WITH aura

Other visual or neurologic sx develop over 5-20 mins and last ~1 hr preceding HA onset
Plus all other accompanying sx once HA develops

Migraine subtypes

Opthalmoplegic: diplopia, transient paralysis of eye movement muscles, ptosis
Hemiplegic: paralysis on 1 side of body
Aphasic: cannot speak
Retinal
Mixed

Mechanisms of Migraines

Constriction, then dilation of arteries
Decreased serotonin activity
Dopamine hypersensitivity
In premenstrual females, cyclic estrogen withdrawal contributes to changes in serotonin and other NT's and cause a rise in serum prostoglandins that promote migraine

Migraine triggers

Fasting
ETOH (alcohol) intake
oral contraceptives
menstruation
hormone replacement
stress
caffeine withdrawal
sleep disturbance
bright lights
scents
smoke
certain foods
taruma

Migraine treatment

Analgesics: Tylenol, Ibuprofen, Percocet, etc...
Fioricet (acetaminophen/barbituate/caffeine)
Midrin (Combo drug): dilates cranial and cerebral arterioles

Migraine treatment: abortive vs preventative

Acute treatment to stop or prevent progression of (abort) HA or revers HA that has started
Preventative treatment (given even in the absence of HA) to reduce freq & severity of the migraine attack, make acute attacks more responsive to abortive therapy, & improve pts quality of life

Cluster HA (Histamine HA)

Much more common in males (6:1)
Onset at > 30 yo
unilateral severe pain and retro-orbital or temporal
"Feels like eye is being pushed out"
accompanied by >/= 1 ipsilateral

lacrimation (tears)
rhinnorhea (runny nose)
conjunctival injection (red eye)
periorbital edema
nasal congestion
forehead and facial sweating
miosis (constriction of pupil)
ptosis (drooping eyelid)
eyelid edema

Cluster cont'd.....

most pts restless or agitated during attack
pain at night
duration of pain: 20-60 mins and may occure several time w/in 24 hrs
"Cluster" refers to grouping of HA, usually over period of several weeks
pain free period of months to years is typical

Cluster cont'd......

During a cluster period, attacks occur regularly & may be provoked by alcohol, histamine, or nitroglycerine
pain usually occurs on same side during a cluster period
Intensity is excruciating
unable to lie down & characteristically pace the floor
Even tho histamine injection stimulate the HA, antihistamines DO NOT abort HA
Sumatriptan or dihydroergotamine (DHE) w/ Metoclopramide is 1st line Rx
Lithium
Corticosteroids

About this deck

By: John Berger
Textbook:

Understanding Pathophysiology
Created: 2011-02-20
Size: 20 flashcards
Views: 16

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj