hey guys I've got a quick little um lecture here on headaches it's part of chapter 61 management of patients with neurologic dysfunction but we're just going to focus on headaches for this for purposes of this lecture so headaches also known as stalgia um which basically just means pain in the head it's one of the most common physical complaints lots of people complain of headache you'll see that quite frequently probably had a headache yourself probably from nursing school um there's a couple different kinds so it's divided first into primary and secondary so primary as you go through nursing school you'll learn this primary means it is what it is the problem is the problem secondary means the problem is coming from something else okay so primary headache is is a headache it's not related to anything really else um it's just a headache and it could be a migraine headache attension headache or cluster headache a secondary headache is caused by something else a secondary process so usually an organic cause such as a brain tumor or an aneurysm so secondary caused by something else headache can interfere with your life your activities and can cause significant uh lifestyle problems especially for someone with very debilitating um headaches which we'll get into so if you have somebody coming in complaining of headache um assessment Diagnostics you'll want to get a good health history history um get a a good picture of their stress level any family history any exposure to toxic sub substances and Med history so any history of anti-hypertensive diuretics anti-inflammatories and maois can actually provoke headache so that could be contributing to it physical exam of head and neck looking for any abnormalities and a neuro exam so if there's any neurological abnormalities they may do a CT or MRI so any kind of neuro deficits um other than just a headache um they may want to do a CT or MRI to rule out or to see if it's caused by you know brain tumor aneurism or whatever so continuing with assessment of headache we want to get a good description of the headache so back to our nursing assessment what we learned what kind of pain is it what makes it better what makes it worse um you know is it sharp pain is it dull pain is it aching want to get a history of their medication and use what are they taking for it um so types of headaches May manifest a little bit differently in different people might also change over time most headaches are not serious so most of the time you don't have a brain tumor like I think um but if somebody has persistent headaches that don't seem to respond to typical treatment that would warrant investigation you want to check that out so detailed history and physical assessment detailed neuro exam we want to rule out any other kind of cause we don't want to just say well it's headaches see you we do want to make sure that there's not something else going on um and if there again if there's neuro abnormalities um confusion things like that we want to do some diagnostic testing some CT MRI okay so if we we've ruled those other things out we're going to we've been diagnosed with a headache um it's just headache not a brain tumor um there's a couple different kinds migrain tension type and cluster headaches and I will get into those so migraine is the first one we're going to talk about um this one has a couple of phases migraine headache um is very tends to be severe incapacitating um probably the most one of the more severe ones so I'll get into the phases of the migraine there's a premonitory phase um that happens hours to days before the headache happens you can get depression irritability feeling cold food cravings um diarrhea constipation um there's an AA phase um this is where you get focal neuros symptoms especially a visual disturbance such as light flashes bright spots those are the most common ones light flashing and bright spots um they they can also get numb numbness tingling of lips and face uh hands dizziness and drowsiness that's in the AA phase the headache phase the actual headache the migraine headache that we think of um is severe incapacitating pain light sensitivity also known as photophobia Sound Sensitivity also known as [Music] phonophobia and something called Alodia which is abnormal perception of stimuli so normal stimuli that wouldn't be bothering us is perceived as being very um problematic um a lot of times migraine headache phase is also accompanied with nausea and vomiting post Drome phase is kind of the recovery phase the pain subsides that but the patient is still very tired uh weak they may sleep for an extended period of time um they may have some mood changes and some muscle contractions in the neck and scalp so muscle soreness so medical management of migraine um or what we want to do to manage it so there's abortive or symptomatic and then there's preventive so abortive or symptomatic means that we treat it when the headache first occurs or is in progress so these abortive treatments reliever our limit headache at one set or in progress most common or most specific one inti migraine agent are the triptans so this is sumat triptan narat triptan risot triptan ETC if it ends in triptan it is a specific anti-migraine agent and it is firstline treatment for migraines so what they do is cause Vaso constriction and reduce inflammation to help with the symptoms so it's a symptomatic thing in a schic heart disease it is contraindicated so if your P patient has a schem of heart disease they cannot take a trip tan and there are potential adverse reactions of increased blood pressure drowsiness sweating and anxiety um the oral dosing if you were going to do oral dosing takes effect in 20 to 60 minutes and they may repeat in two to four hours so best if they take it um as soon as soon as it starts trip Tans also come in nasal spray inhalers disintegrating tablets suppository and injections because remember you can get nausea and in with migraines as well so um one of the other routes may be better so we don't vomit it um another anti-migraine agent is ergotamine what that does is acts on smooth muscle to constrict the cranial blood vessels and help with the headache symptoms this is also available in different preparations so oral sublingual subcutaneous I IM rectal or inhalation um but you cannot give triptans anodamine together so they um there can be a prolonged vasoactive reaction so you can't take them together one or the other um is okay but they cannot be taken together aramine does have some side effects of muscle aches and paresthesias I'm going to watch out for that okay so we talked about the abortive or the symptomatic treatments now we're going to talk about uh preventive so some things that they can do or take for prevention so triggers is a big one avoiding triggers there are a lot of migraine triggers um and it's different for different people but fatigue sleep deprivation is a big one um diet there's certain things in your diet that you want to avoid um if a person is subject to migraines and uh foods containing tyramine which would be aged cheeses red wine and beer foods with MSG hermonia sodium glucamine and chocolate which is unfortunate um anyway those are some foods that might be triggers um for women U men mination ovulation can be a trigger um stress Bright Lights depression certain odors even um and even birth control oral contraceptives um can contribute or trigger migraines um they may give beta blockers anti-epileptics anti-depressants ACE inhibitors otens and receptor blockers um those can be helpful for prevention of migraines um there's also monoclonal antibodies um I usually think of these to give um or maybe still do give monoclonal antibodies for Co but actually there's a gene that's been identified in patients with migraine it's found in increased level it's a gene related peptide and these monoclonal antibodies actually are effective um to help prevent migraines in these patients so I thought that was pretty cool all right so that's migraine I'm going to move on to cluster headaches so cluster headaches are unilateral or on one side usually they come in clusters hence the name of 1 to eight daily and this is excruciating pain usually to the eye area the orbit area and it radiates to the temporal facial regions it's described as a penetrating pain usually comes with nasal congestion and eye watering and it'll last 15 minutes to 3 hours to manage a cluster attack um 100% Oxygen by face mask for 15 minutes is helpful subcutaneous sumatriptan or intranasal zat triptan so go back to those trip Tans again so those are cluster headaches um I read that those are not exactly fully understood neither are migrain migraines really um still some research to be done on them moving on to 10 ion type headaches um so this one a lot of times is related to emotional or physical stress it's a steady constant feeling of pressure so that stress is thought to contract the muscles in the neck and scalp contributing to this type of headache starts in the forehead the temple or the back of the neck I get these right across my forehead may be described as bandlike or feel like a weight on top of my head some patient Ed is your book say is to reassure the patient that this is not a brain tumor um if it's been ruled out I guess that it's not a brain tumor um they may treat these with pain relievers anti-depressants and muscle relaxers as symptomatic pain relief local heater massage is found to be helpful for tension type headaches and since it's related to stress stress reduction can be helpful for this type of headache as well so meditation exercise healthy lifestyle um can be helpful for tension type headache so nursing management of headach so the pain is really the major thing so individualize care and treatment so depending on what what kind of headache it is whether it be cluster tension migraine so specific to their kind of headache that they have um prophylactic meds may be used for those recurrent migraines migraines and cluster headaches require abortive medications as soon as possible with onset so as soon as they start getting those symptoms they need to take those uh trip tans first uh usually um as soon as possible so that they can work quicker they're more effective the sooner that they are taken U meds as prescribed so we want to if we're taking care of the patient we want to do meds as prescribed and teach them to take the meds as prescribed uh Comfort measures so quiet dark room remember with migraines especially you get that photophobia or that light sensitivity so quiet dark room can help and you also get the Sound Sensitivity massage can be helpful INF for tension headaches specifically uh local heat application of heat can be helpful so that is nursing management all right so education for the patient helping the patient identify triggers will be a big one so migraine specific triggers are those hormone changes menstrual cycle uh oral birth control pills um oral contraceptives Bright Lights stress depression sleep s deprivation certain odors whatever the patient identifies so sometimes I'll have them keep like a headache Diary of things that they feel like contributed to their headache so those Foods those tyramine containing foods chocolate MSG red wine beer aged cheese watch out for those teach them about their meds um you know when to take them take them as soon as possible Etc um stress reduction is helpful especially for those tension headaches non-pharmacologic therapies so the quiet dark room the massage Etc follow-up care so check them back in with their doctor and encourage healthy lifestyle and health promotion activi so healthy sleep um healthy exercise Etc so that is your headache lecture quick little lecture on there just mainly focusing on the migraines tension headaches and cluster and the treatments for those so that is all for this one