1. HEADACHES mroche updated Review question to ask
Nursing Management
Nursing Assessment
HA History- location and type of pain
Onset, frequency, duration, relation to events (emotional, psychological, physical) time of day of occurrence.

2. HA to report
Sudden, Severe or associated with projectile vomiting, convulsions, stiff neck, confusion, or loss of consciousness, following a blow to the head, pain in eye or ear, persistant headache is someone previously headache free, or recurring headache in children
May have more serious cause and outcome.

3. Tension Diagnosis Careful History taking SKELETAL MUSCLE TENSION
Electromyography (EMG)
Physical Exam
-incr resistance to passive mvt of head
-tenderness of head and neck

4. Tension -no prodone (early signs & symptoms) -bilateral & “bandlike”
-weeks-months-years No N& V
Pressure & tightness
Mild/Moderate & Bilateral (Less severe)
Worse with Activity
Photophobia, Phonophobia

5. Clinical Manefestations of Migraine with or without Aura
Generalized Edema
Irritability, Pallor
Sinus pain and pressure face or eyes
Nausea & Vomiting
Sweating
Prodone include psychic disturbances, gastrointestinal upset & changes fluid bal.
HA diary of episodes with specific details

6. Headache-Migraine Recurring Unilateral or Bilateral pain Triggers
Family History (65%) Females 3 to 1 over males
Onset- childhood or adolescence
Neurologic, Vascular, Chemical factors-VASODILATION & decr v SEROTONIN (NUEROTRANSMITTER)
Several hrs. to several days-more SEVERE
Dx- No specific/History

7. Stages Migraine HA
1,premonition/aura visual disturbances spots, flashing ( minutes)
2.vasoconstriction numbness, tingling face/hand. Feeling nervous/mood changes
3.vasodilitation/serotonin levels v,-N&V & withdrawal light and sound
4.Sensitivity to touch head area involved, exhaustion & deep aching present

8. Headache- Cluster Repeated VASCULAR -VASODILATION
Weeks to months---remission
Can be MOST SEVERE
Onset years
Severe unilateral pain
-Supraorbital, orbital, temporal

9. Cluster HA-other symtoms
Conjunctival injection or lacrination
Nasal congestion or Rhinorrhea
Forehead & facial swelling
Miosis
Ptosis
Eyelid edema

10. Cluster Abrupt Onset No Prodrome Peak in 5-10 min…Last 30 – 90 min
Starts at night
Several times a day – several days
Each cluster 2 – 3 mths
DX: History & CT & MRI r/o other cause

11. Treatment Medication-take aura or early H/A Meditation or Biofeedback
Yoga or Relaxation Training
Cognitive Behavioral Therapy
Acupuncture or Acupressure
Hypnosis
Prevention Triggers

12. Medications Acute: Nonnarcotic Analgesic -ergoramine (Ergomar)
-dihydroergotamine mesylate (Migranal)
Sumatriptan (Imitrex) & other “triptan”ending
-take at the first sign of headache
-action vasoconstriction/dec inflammation
-contraindicated: Ischemic Heart Disease

13. Meds to reduce freq & severity
B beta blockers-used prevention
-propranol (inderal) & atenolol (tenormin) Metoprolol (Lopressor)-inhibit dilation Bl Vessels
Tricyclic antidepressants
-amitripptyline (Elavil)
Serotonin reuptake inhibitors
-Fluoxetine (Prozac) divalproex (Depakote)
-clonidine (Catapres)
Methysergide (Sansert)

14. Prophylactic meds HA Verapamil-pt can’t take Beta Blocker Lithium
Non-steroid Anti-inflammatory (Naprosyn)
One Aspirin per Day
Acute 100% 7-9 L/min X 15-20min

15. Nursing Diagnoses Headache
Acute pain R/T HA as manifested by…. (describe the pain).
Anxiety R/T lack of knowledge about causes and ways to treat HA as manifested by. (Give other symptoms pt having)
Hopelessness R/T chronic pain and interference with normal daily lifestyle and ineffective treatment AMB:.. What patient saying how affecting their life?
Fear R/T HA occuring at any time to disrupt work, family or personal time AMB…What is pt saying how HA is affecting her personal and professional life?

16. Nursing Diagnosis cont
Sleep Pattern disturbance R/T discomfort and inability to maintain usual sleep patterns.
Encourage use pain log/diary including associated or precipitating factors to allow patient to learn some control over HA. Ie weather changes, intense odors or smells, strong or glaring lights, motion travel, changes in sleep habits or hormones (menstrual cycle or menopause, changes sleep habits or diet.

17. Goals Planning Reduced or no pain
Increased comfort and decreased anxiety
Understanding Triggers and TX strategy
Uses Positive coping strategies
Experience Increase Quality of Life

18. Nursing Implementation
Knowledge of Medications & Relaxation Techniques
Quiet Dimly Lit Environment free odors
Massage and moist/heat neck & head
Eliminate foods that trigger HA- vinegar,chocolate, onions, alcohol esp red wine, excessive caffeine, cheese ice cream or milk products, nuts, fermented or marinated foods, nitrates, monosodium glutamate & aspartame.

19. Nursing Interventions cont.
Other Triggers- Smoking, strong perfumes or odors such as chemicals, medications, gasoline,hormone levels/menstrual times
High Altitudes with low Oxygen travel esp Cluster HA.
Fatique or Change in sleep pattern
Allergies
Stress or Tension
Pt teaching