Headaches, trigeminal neuralgia

What is a migraine?

A recurring headache characterized by unilateral throbbing pain

What are the RF for migraine?

• women (3x more common)

• more common in people 25-55

• genetics

What are the consumable triggers for migraine?

• caffeine

• MSG, artificial sweeteners, sugar

• gluten, dairy

• processed foods

• alcohol

• chocolate

What are some personal triggers for migraine?

• stress

• hormone disruption

• allergies

• excessive sexual activity

• muscle aches, neck pain

• sleep disturbances, sleeping late

• exercise, nutritional deficiencies

What are some environmental triggers for migraines?

• smoke

• perfumes

• heat, weather

• lights

What are the s/s of migraine?

• severe steady/pounding/throbbing unilateral headache

  • worsens w/movement

  • gradual onset

• n/v

• photophobia, phonophobia

• irritability

• diaphoresis

• may or may not have aura/prodromal s/s

• lasts 4-72hrs

What are common manifestations of sensory auras?

• tingling or numbness in fingers/mouth

• hearing voices that do not exist

• smelling unusual odors

what are common manifestations of visual aura?

• flashes of bright lights

• blind spots

• distortions

• zigzag lines

what are common manifestations of aphasic aura?

• speech problems

what are common prodromal s/s of migraine?

• change in activity level

• depression

• fatigue, yawning

• difficulty concentrating

• pallor

What are environmental changes that should be made in management of migraine?

• shut doors to create quiet space

• turn lights off in room

• using heating pad on neck if painful/achy

What are migraines treated with?

• Triptans (best if taken during aura stage) - do not give w/cardiac ischemia

• beta blockers

• NSAIDs

• ASA

• Caffeine-containing analgesics

What drugs are used to prevent migraines?

• antiseizure medications

• a-adrenergic blockers (ergotamine, dihydroergotamine)

• botulin toxin a

• tricyclic antidepressants (amitriptyline)

What is a headache?

pain or discomfort in the head/scalp/neck

What is a primary HA?

a headache not caused by a disease or condition

what is a secondary HA?

headaches caused by other disorders or underlying pathology

what can secondary HA be caused by?

• subarachnoid hemorrhage

• brain tumors or masses

• vascular abnormalities

• trigeminal neuralgia

• disease of eyes/nose/teeth

• systemic illness

• meningitis

• encephalitits

• preeclampsia

How are HA diagnosed?

• ruling out aneurysms, tumors, or infections using CT or LP

How does a tension/stress HA oresent?

• bandlike pressure

• neck ache or tenderness

• waxing and waning intensity

• lasts 30mins-7days

How do cluster HA present?

• Severe intense pain; may be described as excruciating or explosive

• swelling around eye, pain around eye that radiates to temple/forehead/cheek/nose/teeth/jaw, eye redness, miosis, lacrimation

• quick onset

• facial flushing, pallor, diaphoresis

• nasal congestion

• occurs at same time in day, as often as 8x per day

• restlessness

What are tension HA treated with?

• ASA

• Acetaminophen

• NSAIDs

• *above meds may be taken alone or in combo w/caffeine, sedatives, or muscle relaxants

how are tension HA prevented?

• Tricylic antidepressants (amitriptyline, doxepin, nortriptyline

• antiseizure drugs (topiramate) - do not stop abrupty

  • divalproex

• B-adrenergic blockers (

• botulin toxin

• SSRIs (prozac, paxil)

• depakote

How are cluster HA treated?

• triptans (nasal, subq) - standard treatment

• O2 mask for 10 mins (causes vasoconstriction)

• a-adrenergic blcokers

How are cluster HA prevented?

• high dose verapamil - monitor cardiac status

• a-adrenergic blockers

• antiseizure drugs (gabapentin, topiramate)

• corticosteroids

• lithium

what is trigeminal neuralgia?

Chronic neuropathy

• frequent episodes of sudden unilateral pain in response to triggers to the face

what are some triggers of trigeminal neuralgia?

• chewing

• brushing teeth

• yawning

• talking

What are the treatment options for trigeminal neuralgia?

• electrical nerve stimulation

• nerve blocks w/local anesthetic

• botulin toxins

• antiseizure drugs

• procedures, surgeries

What antiseizure drugs may be used to treat trigeminal neuralgia?

• tegretol

• topamax

• phenytoin

• gabapentin

• valproic acid

What procedures may be done to treat trigeminal neuralgia?

• balloon compression (to dmg nerve)

• glycerol rhizotomy (injection)

• radiofrequency thermal lesioning (destroys pt of nerve)

what surgeries may be done to treat trigeminal neuralgia?

• microvascular decompression (displacing and repositioning bv compressing nerves)

  • w/ or w/o neurectomy (cutting of the nerve)

• stereotactic radiosurgery (lesion forms on nerve, which disrupts transmission of pain to brain)

How does T1 trigeminal neuralgia present?

• excruciating pain in lips/gums/cheeks/forehead/side of nose

• facial twitching, grimacing

• frequent blinking, lacrimation

• attacks that come+go, last 2-3 mins

  • may occur up to 50x/day

How does T2 trigeminal neuralgia present?

• constant aching or burning pain

• pain may be lower intensity stabbing pain

  • does not subside completely

• no attacks

What nursing assessments should be done for trigeminal neuralgia?

• assess pain attacks in detail

  • triggers, characteristics, frequency, pain management techniques

• assess pain after administration of drugs

• assess nutritional status and hygiene

What patient teaching should be done by the nurse for trigeminal neuralgia?

• eat food that is high in protein and calories, and is easy to chew

• eat small, frequent meals

• important of nutrition, hygiene, oral care

• keep environmental stimuli to moderate level

• use stress reduction methods

What nursing interventions should be implemented for trigeminal neuralgia?

• assessments

• educationan

• administration of drugs

  • analgesics, convulsants

• providing emotional support