migraines/other headaches

headache types

tension

cluster

migraine (neurological disorder)

sinus

sinus headache

pain behind brow bone-cheekbones

cluster headache

severe pain around one eye

multiple/day

tension headache

band-like squeezing around head

mild-moderate pain

migraine

throbbing pain

nausea

visual changes (aura)

pathophysiology of migraine headache

what happens in body

1. trigeminal nerve stimulated

2. painful neurogenic inflammation

3. neurogenic vasodilation

4. inflammation → pain

vascular + neurologic

major manifestation tension headache

bilateral

non-throbbing

mild-moderate

pressure or band-like feeling

heavy feeling in head/shoulder

major manifestation cluster headache

severe, unilateral

near eye (orbital)

up to 8 times/day

lacrimation (tearing)

rhinorrhea (runny nose)

major manifestation migraine headache

unilateral

pulsating, throbbing

moderate-severe

phases:

1. prodrome

2. aura (may/not)

3. headache

4. recovery

major manifestation menstrual migraine headache

caused by drop in estrogen

occur 2-3 days before menses

similar to typical migraine symptoms

visual aura

flashing lights

blind spot

zig-zag line

visual distortion

migraine drug therapy drug classes

NSAIDs

triptans

NSAIDs + triptan combo

acetaminophen-aspirin-caffeine

ergot alkaloids

estrogen (menstrual)

antiemetic

NSAIDs

prototype: naproxen or naproxen sodium

MOA: COX 1&2 inhibition, aleve work faster

use: reduce pain from acute migraine

naproxen or naproxen sodium nursing consideration

BBW

• cardiovascular event

• GI bleed

contraindication: pregnancy, lactation

triptans

prototype: sumatriptan

MOA: bind to serotonin receptor (5-HT)

use: acute migraine or cluster headache

sumatriptan nursing consideration

adverse effect: CNS/CV effect

routes:

• oral

• patch

• intranasal

• sub-Q

serotonin syndrome

NSAIDs + Triptan

prototype: sumatriptan + naproxen

BBW:

• CV risk (MI, stroke)

• GI bleed

High-risk combo → assess cardiac history

acetaminophen-aspirin-cafeeine

MOA: analgesia, anti-inflammatory, vascular constriction

use: reduce pain for migraine/tension headache

acetaminophen-aspirin-cafeeine nursing consideration

adverse effect

• hepatotoxicity

• GI effect

• hypertension

• palpitation

contraindication:

• hepatic disease

• alcoholism

• diabetes

• pregnancy

ergot alkaloids

prototype: ergotamine tartrate

MOA: constrict cranial & peripheral blood vessels

nursing consideration

ergotamine tartrate nursing consideration

CV side effect: fibrosis, gangrene

BBW: CYP3A4 inhibitor

• fluconazole

• azithromycin

not for children

CYP3A4

normal: Drug → metabolized by CYP3A4 → safe elimination

with CYP3A4 inhibitor:

• drug builds up

• toxicity risk increase

ergotamine tartrate dangerous with certain meds

estrogen

prototype: estradiol

MOA: take prophylactically to prevent decline estrogen

use: menstrual migraine

estradiol nursing consideration

adverse effect: thromboembolic disorder, chest/leg pain

contraindications: breast cancer, pregnancy

antiemetic drug

prototype: chlorpromazine HCI

MOA: suppresses chemoreceptor zone

use: nausea/vomiting associated with headache

nursing consideration: CNS depression

chlorpromazine HCI nursing consideration

CNS depression

nursing process for patients w/migraine headache

NSAIDs: CV events, GI bleeding

Acetaminophen combos: liver toxicity, HTN, interactions

Ergot alkaloids: CV effects, fibrosis, drug interactions

Triptans: BBWs (CV + GI risk with combo)

Estrogen: thromboembolism

assess: cardiac hx, pregnancy status, drug interaction