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ATI Med-Surg: Chp 11: Headache
Terms in this set (12)
● Headaches may be acute or chronic, temporary or life-threatening.
● Headaches are a common occurrence and affect individuals of all ages; headaches are associated with other conditions such as colds, allergies, and stress or muscle tension.
● Primary headaches have no organic cause that can be identified. They include migraine headaches, tensionlike, and cluster headaches. They can be managed in the primary care setting.
● Secondary headaches are associated with an organic cause, such as a brain tumor or aneurysm, and warrant further investigation and medical management.
● This chapter includes migraine headaches and cluster headaches.
Health Promotion and Disease Prevention
● Promote stress management strategies and recognition of triggers of the onset of a headache.
● Promote hand hygiene to prevent the spread of viruses that produce coldlike symptoms.
● Review pain management to include over-the-counter medications and herbal remedies.
● Review risk factors (triggers) for both migraine and cluster headaches.
◯ Alcohol or environmental allergies
◯ Intense odors, bright lights, overuse of certain medications
◯ Fatigue, sleep deprivation, depression, emotional or physical stress, anxiety
◯ Menstrual cycles and oral contraceptive use
◯ Foods containing tyramine, monosodium glutamate (MSG), nitrites, or milk products
Migraine headaches: Assessment
● Subjective Data
◯ Photophobia and phonophobia (sensitivity to sounds)
◯ Nausea and vomiting
◯ Stress and anxiety
◯ Unilateral pain, often behind one eye or ear
● Objective Data
◯ Health history and family history for headache patterns
◯ Alterations in ADLs for 4 to 72 hr
Migraine with auras
■ Prodromal stage: includes awareness of findings for hours to days before onset: irritability, depression, food cravings, diarrhea/constipation, and frequent urination.
■ Aura stage: develops over minutes to an hour to include neurologic findings: numbness and tingling of mouth, lips, face, or hands; visual disturbances (light flashes, bright spots).
■ Second stage: severe, incapacitating, throbbing headache that intensifies over several hours and is accompanied by nausea, vomiting, drowsiness, and vertigo.
■ Third stage (4 to 72 hr): headache is dull. Older adults may continue with aura, and pain subsides (visual migraine).
■ Recovery with pain and aura subsiding. Muscle aches and contraction of head and neck muscles are common. Physical activity worsens pain, and client may sleep.
Migraine without Aura
■ Pain is aggravated by physical activity.
■ Unilateral, pulsating pain.
■ One or more of these manifestations present: photophobia, phonophobia, nausea, and/ or vomiting.
■ Persists for 4 to 72 hr; often occurs in early morning, during periods of stress, or with premenstrual tension or fluid retention.
■ Headache lasts longer than 72 hr.
■ Neurologic manifestations persist for 7 days.
■ Ischemic infarct may be found on neuroimaging.
■ Does not fit other criteria.
Migraine: Nursing care (during headache)
◯ Maintain a cool, dark, quiet environment.
◯ Elevate the head of the bed to 30°.
◯ Administer medications as prescribed.
◯ Abortive therapy to alleviate pain during aura or soon after start of headache.
■ For mild migraines: NSAIDs (ibuprofen, naproxen), acetaminophen, and over-the-counter anti-inflammatory medications in formulations for migraines (Advil Migraine Capsules).
■ Antiemetics (metoclopramide [Reglan]) to relieve nausea and vomiting.
■ Severe migraines
☐ Triptan preparations (zolmitriptan [Zomig], sumatriptan [Imitrex], eletriptan [Relpax]) to produce a vasoconstrictive effect.
☐ Ergotamine preparations with caffeine (Cafergot, dihydroergotamine [Migranal]) to narrow blood vessels and reduce inflammation.
☐ Isometheptene in combination formulations (Midrin) when other medications do not work.
◯ Preventive therapy for frequent headaches or when other therapies are ineffective.
■ NSAIDs with beta-blocker (propranolol [Inderal]), calcium channel blocker, beta-adrenergic locker or antiepileptic medications (divalproex [Depakote], topiramate [Topamax]).
■ Client is instructed to check pulse when taking beta-adrenergic blockers and calcium channel blockers.
Migraines: Client Education
◯ Review "Three R" approach with client (www.headaches.org).
■ Recognize migraine manifestations.
■ Respond and seek provider.
■ Relieve pain and manifestations.
◯ Remain in a cool, dark, quiet environment.
◯ Elevate the head of the bed as desired.
◯ Educate women over age 50 about risk factors for cardiovascular disease and stroke.
◯ Review trigger avoidance and management.
■ Educate about foods with tyramine (such as pickles, caffeine, beer, wine, aged cheese, artificial sweeteners) and foods with MSG or preservatives.
■ Review current medications for those known to induce migraines: ranitidine, estrogen, nitroglycerin, and nifedipine.
■ Discuss anger issues and handling conflict.
■ Reinforce the need for adequate rest and sleep.
■ Review travel involving a change in altitude.
■ Reinforce the need to avoid light glare or flickering lights.
■ Review client's menstrual cycle pattern and hormone fluctuations.
■ Discuss avoiding intense environmental odors, perfumes, and tobacco smoke.
◯ Educate client about use of complementary and alternative therapies.
■ Provide referral to community centers offering yoga, meditation, tai chi, exercise, and massage for relaxation and to alleviate muscle tension.
■ Provide referral to acupuncture and acupressure therapy, which may be helpful for pain management.
■ Herbal remedies and nutrition supplements should be reviewed with the provider because there is insufficient evidence to support their use in management of migraines.
Cluster Headaches: Assessment
◯ Brief episode of intense, unilateral, nonthrobbing pain lasting 30 min to 2 hr that can radiate to forehead, temple, or cheek
■ Occurring daily at about the same time for 4 to 12 weeks
■ Followed by period of remission for up to 9 to 12 months
◯ More frequent during spring and fall
◯ No warning signs
◯ Less common than migraines
◯ Men between 20 to 50 years of age
◯ Tearing of the eye with runny nose and nasal congestion
◯ Facial sweating
◯ Drooping eyelid and eyelid edema
◯ Facial pallor
◯ Nausea and vomiting
◯ Pacing, walking, or sitting and rocking activities
Cluster headaches: Medication
● Medications (see medications for Migraine Headaches)
◯ Ergotamine preparations
◯ Antiepileptic medications
◯ Calcium channel blockers
◯ Over-the-counter capsaicin
● Home oxygen therapy at 7 to 10 L/min for 15 to 30 min may be helpful at onset of headache.
Cluster Headaches: Client education
◯ Remain in a cool, dark, quiet environment with head elevated.
◯ Remain in sitting position when using oxygen, and maintain safety precautions when using oxygen in the home.
◯ Review prevention strategies.
■ Wear sunglasses to reduce light and glare.
■ Obtain adequate rest and sleep, exercise, and relaxation.
■ Avoid foods containing tyramine, MSG, and nitrites (preservatives).
■ Review of risk factors (triggers) for headaches.
☐ Anger outburst
☐ Anxiety and prolonged anticipation, or periods of stress
☐ Excessive physical activity, fatigue
☐ Altered sleep-wake cycles
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