headache Concept map

tension

cluster

mixed

sinus

migraine

migrane risk factors

Poor diet, lifestyle, social standing

Increased levels of C-reactive protein( blood marker for information if there is an inflammation in the blood in the arteries marker for upcoming heart issues )
Increased levels of interleukins( auto immunie and inflammation
Increased levels of TNF-alph (tumor necrosis factor is a marker that the acute phase of the inflammation process has started )
Oxidative stress and thrombosis
Increased body weight
High blood pressure
Hypercholesterolemia
Impaired insulin sensitivity
High homocysteine levels
Stroke
Coronary heart disease

homocysteine level -

oxiative stress = imbalance of freee radicals( are oxygen molecules that have more than one electron=very reative to other molecules . So if they react with DNAor lipids or proteins molecules =unstable = major free radicals .

Antioxideants - they can give up a molecule to the radical and still be stable and have no damage doen to the cell

4 phases of a migraine

Prodromal phase - Early warning signs ,prior to migrane unusual sensations , crave certain foods certain triggers .

s/s you experience being

Depressed or cranky.
Very happy, very awake, or full of energy.
Restless or nervous.
Very sleepy.
Thirsty or hungry,Or you may not feel like eating.

Aura Phase- no real migrane yet, Strange sensations , vision changes , flickering lights, imagine past, hallucinations, skin sensations like pins and needles , diffulty with communication

aura usully starts 30 minutes before migraine starts .

Visions ; spots, wavy lines, or flashing lights .

attack phase - migraine actually begins. Can last for hours or days. Pain above the eyes . Throughout the head, intense throb increase pain with exercise or exertion, very sensitive to light

s/sThrobbing pain Pain behind one of your eyes.
Moderate to very bad pain. Pain so intense you can't do your normal things
Pain that gets worse with routine physical activity.
Nausea, vomiting, or both.
Pain that gets worse when you e experience noise and smells

If you have some of these symptoms check with yoru dr. you might be having tia

dr 911Problems speaking.
Tingling in your face, arms, and shoulders.
Short-term weakness on one side of your body.

postdromal phase after the storm . Not feel well up to a day after .tires quicly and sluggish , lethargic and confused

s/s fatigue.
lowered intellect levels.
lowered mood levels, especially depression, or feelings of well-being and euphoria.
poor concentration and comprehension.

Migraine Is a recurrent throbbing that is severe affecting one side of the head usually followed with nausea , disturbed vision usually preceded by sensory warnings

Sinus headache is cause by usually an inflammation in the sinus cavities in the brain. It is a buildup of fluid that causes te pressure on the membranes that causes the pain .

Mixed headaches are a combination of tension headaches and migraines. it is believed that the migraine starts first causing the tension in the muscles causing the tension headache as well. This class has symptoms of both can last up to 72 hours from dull to throb and mild to severe pain. Activity tends to make it worse. It used to be called mixed headache syndrome

Cluster headaches are rare , they are severely painful , the come in cylces of clusters, last weeks to months that are followed by periods of remission.

tension headache is the most common . affects your visionan and can cause nausea. Feel like a band is stretched over yoru forehead tightly

Medications

prophalactic medications- givens as a preventative , deceresase the frequentcy and severity , make the acute attacks more receptive and respond better to abort therapy

Types of meds that are prophalactic( preventaive types)Beta-blockers propanalol,Toprol ,metoprolol, which relax blood vessels
Calcium channel blockers- Cardizem (dilatizem) and verapamil, which reduce the amount of narrowing of the blood vessels
Antidepressants- amitriptyline and nortriptyline ,tricyclic antidepressants
Anticonvulsants -Depakote ,valproic acid,Topamax
Botox (botulinum toxin), which can be injected in small quantities around the face and scap

means of taking prophalactic- most of them are oral

abortive medications

triptans are a type of medications that are targeted to affect the chemial seratonin which is usually low in migrane sufferse. It narrows the blood vessels reieving the swelling

Sumatriptan (Imitrex)
Sumatriptan/Naproxen (Treximet)
Zolmitriptan (Zomig)
Eletriptan (Relpax)
Naratriptan (Amerge)
Rizatriptan (Maxalt)
Frovatriptan (Frova)
Almotriptan (Axert)

do not use more than 2x daily, and do not use more than 3 x in a week

means of taking triptans -tablets, injectables,nasal spray

Ergot Alkaloids - acts a s a vasoconstrictor of the carotid arteries. These types of meds have a sertonegic effect , which means that it stimulates the serotonin levels in the brain. Sufferer tend to have lower levels of serotonin

means of taking - injection , sublingual , or rectally

Black box warning - do not mix ergotamine and CYP3A4 inhibitors = cerebral ischemia . Could cause a thombus teratogentic warning - could cause premature contractions=miscarriage , fetal distress,

abortive medications are specifically for compete and effective migraine treatment. They can be sued to prevetn the attack or stop the attack during the prodromal stage .

Prevvent attack can be given during th prodroal stage to stop proceeding .

Means of taking - can be given via inject to thigh , wafer melt on tongue,nasal spray, As of 2013 Sumatiptan is now available as a patch

most effective 15 minutes after first symptom

alternative medications/ treatments/ vitamins/tea

bio feed back _ technique to learn how to control your own body functions based on info from electrodes and how it is interpreted ..It helps narrow specific situations behaviors or thoguhts and allow the patients to recognize thougths and behaviours and how it influences their body symptoms. Therefore a form of mind over matter

thermal biofeedback- measures skin temp

electromyography - measures muscle tension

neurofeedback - measures brainwave activity

Accupunture - the insertion of thin needles into energy median on the basis that the tract are blocked

massage therapy

Cognitive behavioural therapy

Vitamin B-2

Co enzyme 10

Magnesium suppletment s

helps relax the muscles

helps with cell function, repairs damaged cells , helps to create energy

Riboflavin , enhances a component substance ta the body need to create energy production. help in the growth and developmetn of red blood cells

this is a transportable treatment that can be done by the patient anywhere. No side effects . Keepin in mind the gate theory . Negative thoughts and emotions =gate open =increase in pain . Possitive thought s and emotions = closed gate=decrease in pain .Our pain is influeneced by our emotions and actions and thoguths. No side effects

Is considered a proactive and active treatment. It enhances optimum levels of relaxation= realxe muscles/spasms and pressure point triggers , lowers the chances of a stress induced migrane

teas-

green tea , oolong tea chamomile - careful if pregnant can cause miscarriages, low birht wts, decrease in growth to fetus , can make astha attack worse

basic 5 steps of tx of a migraine - diagnosis , assess the level of disability Physical,mental, psychological , patient ability to be educated and what they already know , there own individual management system , layering of treatments

treatment goals

decrease migraine frequency intensity,decrease pain , increase relief stop symptom,improve quality of life ,educate patient on medications and treatments so that they can be the most effective for them ,

Make sure that you ask the patient how long this has been going onDo they have a regular Dr. tx , what meds tx"s therapies are they taking now . how are they physically manifesting ,what is the pain scale they are at , Asess the level of pain and or discomfort and how it affects their day life , suggest rest in quiet room, discuss triggers , food meds stress ,compress on forehead, encourage alternative therapies if interested , discuss stress relief , change of lifestyle

lifestyle

stress

food/diet/hydration/meds/vitamins /suppletments

alternative choices

ride your bike to work once a week instead of the care or take the bus .

discuss food portions and the types of processed diet taht they eat ? how much water do they get? Maybe a med review could be in order if they are oon some kind of hormone therapy? what vitamins could they take , or supplemetns .

growing a garden , or joining a foodshare group, or community garden . Sharing meal preperations with freinds doing potlucks .

what is causing the stress ? can it be eliminated or modified. COuld councleling work to empower them to remove the stress

money ? is this an issues ? Is there a way that a budget could be made to stream line and to purchase a healthier diet pand

discuss what they think the factors are that can be modified or eliminated

Join a gym, seting a walk plan , meditaite, joing a group

Assessment questions?

How long has this been going on ? Have your been journallling what is happening?

pain level -1-10

describe the pain ? heavy throbbing stabbing constant location things that make it worse or better

observe for nonnverbal cles of pain -posture restlessness / grimacing crying diaphresis (sweating ) HR increase breathing rapid

3 main questions to ask to determine if it qualifies as a migraine

has this headache been limiting your activities for the last 3 months or longer

do you feel nausea or stomach when you have a headache

do you find that the light bothers you ?

if you answer yes to altelast 2 you have a form of miograne headache

Medical imaging

Ct cross sections images used to diagnose tumor or infection or brain damage or bleeding

MRI - magnetic field and radio waves produce images of the blood vessels

Lumbar puncture -checking for infection or bleed , needle into the spine aspirating cerebralspinal fluid for analysis . beware that the side effects can be a very extreme headache

reasons for getting a LP1st or steady worsenting , Severe rapid onset progressively getting worse

Reason for tests- Dr is unable to be diagnos based on symptoms and neuro exam .Thuderclap , Different from other headaches you have had , over 50, gets worse with exercise , comes with fever ,seizure , vomiting, change of vision or speech

testing for blood vessels problems , infection of brain or spinal cord, checking for toxins

Esr erythrocyte Sedimentation rate, C reative Protein

Primary

Overactive paind senstive areas in the structures of the brain . No underlying cause like secondary. Could be a genen that is carried forward

secondary - underlying cause -stroke hemmorhage , infection siutitis .

SSNOOPS systemic symptoms fever wt loss , Secondary risk factor HIV cancer, Neurological symptoms confusion impaired alertness ,Onset sudden abrupt split second , Older -new onset progressive headache over 50 , Previous headache history pattern changes

neurological reasons for a headache

Subtopic

symptoms of neurological migraine

1.pain on one side or both sides of face and head, consistent rhythmic throbbing ,difficulty thinking concentrating ,disrupted motor coordination,

Subtopic

Subtopic