11 headaches

Tension headache

Stress induced muscle tension

Tension headaches most commonly occur

In a band around the forehead and wraps around the head

Tension headaches can also occur in a pattern similar to

Having a cap on your head

Cluster headaches get the name from

Occurring in clustered time periods

Cluster headaches could occur

Several times in one day

How long do cluster headaches last for?

Minutes to a few hours

Cluster headache pain generally occurs

On one side and is extremely painful

Cluster headaches have associated manifestations

On the same side that occur as teary eye, runny nose or stuffiness, diaphoresis

Where do cluster headaches most frequently occur?

Over or behind the eye

Where do cluster headaches occur but less commonly?

Nose, eye ear area and least commonly occur in the jaw area

Laypeople may use migraine when describing

A bad headache but it may not be a migraine

Migraines have a

Hereditary component

Migraines are more common in

Women

Migraine pain

Throbbing pain on one side of the head

Migraines can last

Hours to days

Migraines occur most commonly

In the temporal area

Migraines can occur less commonly in the

same temporal area but on a larger scale

With migraines, what are common?

Prodromal auras

Prodromal aura

Flashing, confusion, paraesthesias (numb tingling)

With auras, patients could also get

N&V, sensitivity to noise, photophobia

Auras and migraines may

Impact daily life, work, school, and relationships

What is the most common migraine symptom?

Headache pain

What may be used to identify migraine triggers?

Headache diary that includes activities and food triggers

Migraine food triggers

Nitrates and Nitrites, tyramine, alcohol, red wine, MSG, caffeine, high sodium diet

What are some other potential migraine triggers

Fasting, nicotine, oral contraceptives, hormonal changes, changes in physical activity, stress, sleep patterns, and weather

MORE potential migraine triggers

Exposure to pollution, chemicals, perfumes, flashing lights, analgesic rebound headaches (gradually wean from meds)

Nursing diagnosis for headaches and migraines

Acute pain

For migraines, what could help

Lie in a dark room that is quiet for noise sensitivity and photophobia

What could be taken for migraines?

Serotonin receptor agonists (triptans)

Triptans are contraindicated with

Coranary Artery disease

Chest pain when taking Triptans could indicate

Underlying CAD

Most common side effects of Triptans

Dizziness and drowsiness

Administer triptans when

At first sign of migraine

What are the possible forms of triptans a patient could take?

Sub!, PO, disintegrating tablet, or nasal spray

Sumatriptan

SubQ or nasal spray

Zolitriptan

PO or disintegrating tablets

If one triptan does not work

A different one may work

Sumatriptin and imitrex have

A pen that makes delivering the med SubQ much easier

What else could be used for migraines?

Small-molecule Calcitonin Gene-related peptide (CGRP) receptor antagonist

What are examples of CGRP receptor antagonists

Rimegepant ODT, ubrogepant, and atogepant (___gepant)

CGRP receptor antagonists provide

Rapid relief with a single dose (2 hours)

What are side effects of CGRP receptor antagonists

Nausea and UTI

Serotonin (5-HT)1F receptor agonist (Ditans-lasmiditan) relief in

Rapid relief of symptoms (~2 hours)

Side effects of (5-HT)1F receptor agonists

Dizziness, fatigue, somnolence (do not drive within 8 hours of dose)

What else can be given for patients with migraines

Antiemetics (ondansetron that can be given oral, disintegrating tablets, IV)

Are narcotics recommended for patients with migraines?

No, they do not address the cause of migraines and risk addiction

What could be given to prevent migraines

Tricyclic antidepressants

Side effects of tricyclic antidepressants

Dry mouth, drowsiness, urinary retention, weight gain

What may make SSRI antidepressants better than tricyclic antidepressants?

Fewer side effects

What else can be used to prevent migraines?

Beta blockers (____olol)

Corticosteroids

Seizure medications

Seizure medications

Divalproex

Side effects of divalproex

Weight gain, nausea, drowsiness, teratogenic (birth defects)

Erenumab-aooe

Monoclonal antibody

How do monoclonal antibodies work

Clacitonin gene-related peptide (CGRP) dilates blood vessels and is a neurotransmitter involved in pain

Erenumab-aooe blocks

CGRP receptors

Erenumab-aooe when used for prevention is given

Monthly subQ with an autoinjector

Side effects of erenumab-aooe for prevention

Injection site reactions, constipation

What could occur with Erenumab-aooe for prevention

Anaphylaxis

The autoinjector for Erenumab-aooe is

Latex+

What supplements can prevent migraines?

Magnesium oxide or magnesium glycinate, Vitamin B2(riboflavin), Coenzyme Q 10

What is a less thought of method of preventing or treating migraines?

Injection of botox into head and neck

External neurostimulation can be used to

Treat headaches and prevent headaches in the future

When could an implanted deep brain stimulator be used?

When everything else was unsuccessful in treating the migraines and headaches

Acute treatment for cluster headaches

Oxygen therapy during the headache

Prevention for cluster headaches

Calcium channel antagonists, lithium, prednisone