Test 3 Headaches (CNS, Brain)

Question 1

What are the 2 types of headaches?

Answer 1

Migraine headaches

Cluster headaches

Question 2

What are the risk factors for headaches in general?

Answer 2

• Alcohol
• Environmental allergies
• Medication
• Intense odors, bright lights
• Fatigue, sleep deprivation
• Depression
• Emotional/physical stress, anxiety
• Menstrual cycle, oral contraceptive use

Question 3

What are the Foods (triggers or risks for headaches)?

Answer 3

(Triggers or risk factors for heachaches)
Food containing tyramine: (nuts, pickles, caffeine, beer, wine, aged cheese, artificial sweeteners, sugar-free beverages)

caffeine, monosodium glutimate (MSG), nitrites, milk products

Question 4

What is the pathology is migraines?

Answer 4

Migraines are Multifaceted:

• Vascular
• Genetic
• Neurological
• Hormonal
• Environmental

Question 5

What are the symptoms of migraines?

Answer 5

Migraine symptoms:

• Intense pain, UNILATERAL (often behind one ear or eye)
• Descriptor –> Throbbing
• Worsens with movement
• Photophobia or phonophobia (sensitive to sound)

Question 6

What are the 3 categories of migraine?

Answer 6

Migraines have 3 categories:

• Aura (Classical migraine)
• No aura (Common migraine)
• Atypical

Question 7

Migraines:

What are the stages or phases of the Aura category?

Answer 7

Aura category:

-Prodromal stage
-Aura stage
-Second stage
-Third stage
Sense of migraine coming on

Question 8

Migraine: With Aura

What is the prodromal stage?

Answer 8

Include awareness of findings for hours to days before onset: irritability, depression, food cravings, diarrhea/constipation, and frequent urination

Question 9

Migraine: With Aura

What is the Aura stage?

Answer 9

Develops over minutes to an hour and includes: numbness/tingling of mouth, lips, face, or hands; visual disturbances (lights flashes, bright spots)

Question 10

Migraine: With Aura

What is the Second stage?

Answer 10

Severe, incapacitating, throbbing headache that intensifies over several hours and is accompanied by nausea, vomiting, drowsiness, and vertigo (dizzy spells)

Question 11

Migraine: With Aura

What is the Third stage?

Answer 11

(4 to 72 hours)
Headache dull
Older adults may continue with aura, and pain subsides (visual migraine)

Question 12

Migraines:

What are the characteristics of the No Aura (common migraine) category?

Answer 12

No aura:

• 4 to 72 hours duration
• Pain aggravated by physical activity
• One or more of these present: photophobia, phonophobia, nuasea, and/or vomiting
• Unilateral, pulsating pain

Question 13

Migraines:

What are the characteristics of the Atypical category?

Answer 13

Atypical:

• Headache lasting longer than 72 hours
• Ischemic infarction may be found on neuroimaging
• Neuro manifestations persist for 7 days
• Do not fit other criteria (unclassified)

Question 14

Migraine (Patient Education):

What is the migraine “Three R” approach with a patient?

Answer 14

Migraine (Patient Education):
“Three R” approach:

“R”ecognize migraine symptoms
“R”espond and seek health care provider
“R”elieve pain and associated symptoms

Question 15

What are nursing care considerations during a headache?

Answer 15

Nursing care during a headache:

• Maintain a cool, dark, quiet environment
• Elevate HOB to 30 degrees
• Administer medications as prescribed

Question 16

Abortive Therapy:

What are the abortive therapy medications to alleviate MILD migraine pain?

Answer 16

Abortive Therapy:

• Acetaminophen
• NSAIDs (Ibuprofen, naproxen)
• OTC anti-inflammatory (Advil Migraine Capsules)
• Antiemetics to relive N/V: metoclopramide (Reglan)

Question 17

Abortive Therapy:

What are the abortive therapy medications to alleviate SEVERE migraine pain?

Answer 17

Abortive therapy:

• Triptan preparations
• Ergotamine preparations
• Isometheptine combination

Question 18

Abortive Therapy:

How do the Triptan preparations work against SEVERE migraines?

Answer 18

Abortive therapy: Severe migraine

Triptan preparations produce a vasoconstrictive effect.

zolmitriptan, sumatriptan, eletriptan

Question 19

Abortive Therapy:

How do the Ergotamine preparations preparations work against SEVERE migraines?

Answer 19

Abortive therapy: Severe migraine

Ergotamine preparations with caffeine narrow blood vessels and reduce inflammation.

-Cafergot, dihydroergotamine (Migranal)

Question 20

Abortive Therapy:

When is the Isometheptene combination formulations against SEVERE migraines used?

Answer 20

Abortive Therapy: Severe migraine

Isometheptine in combination formulations (Midrin) used when other medications DO NOT WORK.

Question 21

Preventative Therapy:

What are the preventative medications given for frequent headaches or when other therapies are ineffective?

What is important to instruct patients to do with these medications?

Answer 21

Preventative Therapy:

• NSAIDs with: (Drugs below)
• Beta blocker: Propranolol, timolol,
• Calcium channel blocker: verapamil
• Antiepileptic drugs: Topiramate, divalproex (Depkote)

***Instruct patient to check pulses when taking beta-adrenergic blockers and calcium channel blockers.

Question 22

Preventative Therapy:

What are some foods with tyramine to avoid?

What else should be avoided?

Answer 22

Preventative Therapy:

• Avoid foods with tyramine (nuts, pickles, caffeine, beer, wine, aged cheese, artificial sweeteners, sugar-free beverages)
• Avoid foods with MSG or preservatives

Question 23

Preventative Therapy:

What medications are known to induce migraines?

Answer 23

Medications known to induce migraines:

ranitidine, estrogen, nitroglycerine, nifedipine

Question 24

What are cluster headaches?

How long do they last?
How often do they occur?

Do they radiate?

Are there warning signs?

Are they seasonal?

Answer 24

-Cluster headaches are brief episodes of intense, unilateral non-throbbing or boring pain. (trigeminal autonomic cephalalgia)

• Lasting 30 minutes to 2 hours
• Occurring daily at about the SAME TIME for 4 to 12 weeks
• Yes, can radiate to forehead, temple, or cheek.
• No warning signs
• Yes, cluster headaches are more frequent during the fall and spring.

Question 25

What is the patho of cluster headaches?

Answer 25

Cluster headache Patho: Vasoreactivity and Neurogenic inflammation

Question 26

What are symptoms of cluster headaches?

Answer 26

Cluster headache Symptoms: - Tearing of eye with nasal congestion - Facial sweating - Drooping eyelid (ptosis) and eyelid edema - Miosis - Facial pallor --> Very white - Nausea & vomiting - Pacing, walking, and rocking activities

Question 27

What are the medication treatments used for cluster headaches?

Answer 27

Cluster headache: Mediation treatments: - Triptans - Ergotamine preparations - Antiepileptic medications - CCC, Lithium, Corticosteroids - Melatonin, Glucosamine - OTC Capsaicin

Question 28

What should be taught for the oxygen therapy used for cluster headaches?

Answer 28

Oxygen therapy: - 100% for short periods of time during headache, the d/c - Remain in sitting position when using oxygen, and maintain safety precautions when using at home.

Question 29

What are some strategies to prevent cluster headaches?

Answer 29

- Wear sunglasses - Obtain adequate rest, exercise, relaxation - Avoid tyramine MSG, nitrates (preservatives)

Question 30

What are the risk factor (triggers) for cluster headaches?

Answer 30

Cluster Headache Risk factors: - Anger outburst - Stress - Excessive physical activity - Altered sleep-wake cycles