Headaches

1. Triggers: Caffeine, Red Wine, Stress, Change in weather
2. Three categories: With aura, Without aura, and Atypical

   Nota:

   • What is an aura? Sensation such as visual changes that signals the onset of a headache or seizure *Most headaches are migraines without aura *Atypical migraines-less common & are menstrual and cluster migraines
   1. Occurrence w/o aura: Episodic, Lasts 4-72 hours
   2. Occurrence atypical: lasts more than 72 hours
3. Symptoms: Unilateral, Intense stabbing pain, worse with movement, N/V, photophobia/phenophobia

   Nota:

   • What is photophobia? light sensitivity  What is phonophobia? sound sensitivity 
4. Treatment: Abortive therapy, Medication, CAM

   Nota:

   • Treatment: 1.) Abortive therapy: Stop the pain at the aura phase 2.) Medication (Mild) 3.) Medication (Severe) CAM therapies- yoga, meditation, relaxation, massage, exercise, acupuncture
   1. MILD Meds
      1. Acetaminophen
      2. NSAIDS
      3. Antiemetics for N/V
      4. Reglan

         Nota:

         • Administered with NSAIDS to promote gastric emptying and decrease vomiting  -Increases motility in gut
   2. SEVERE Meds
      1. Triptan

         Nota:

         • -relieves headache and symptoms by activating receptors on the cranial arteries  -Given nasal, PO, & IM -Does not go well with SSRI's; overdose of SSRI and then issues in the brain -Also does not go well with St. John's Wart 
         1. Zomig
         2. Imitrex
         3. Patient teaching/Safety

            Nota:

            • -Take triptan as soon as migraine develop -report angina to prevent damage or myocardial ischemia -Use cntraception -common side effects: flushing, tingling
   3. Other drugs: calcium channel blockers, antiepileptic, beta blockers

      Nota:

      • Pt teaching for cardiac drugs: check pulse and report bradycardia or fatigue and SOB

1. Triggers: Stress, Alcohol, Relaxation, Napping, REM sleep
2. Occurrence: 30 mins - 2 hours, unilateral pain; CHRONIC

   Nota:

   • -Reoccurs every few weeks -Brief periods of pain during the same time (mornings ex.)
3. Symptoms: Excrutiating, nonthrobbing, rhinorrhea, ptosis, facial edema
4. Treatment: Meds, O2, Surgery, CAM

   Nota:

   • *Same drugs for migraines: Triptans, Calcium channel blockers, antiepleptics -Lithium and corticosteroids -O2-15-20 mins (high flow mask) -Surgery-Trigenimal nerve

Nota:

• Assessment of Headaches:  1.) rule out anything else 2.) Pain assessment-0-10, PQRST 3.) Get History & Physical 4.) Clusters or Migraines?