MN568 Headaches Essay
Headaches are classified as primary and secondary. Primary headaches include migraine, tension-type, cluster, and other such as sinus-related or hormonal. Secondary headaches are red flags for trauma, metabolic, neurological or substance withdrawal (Hainer & Matheson, 2013). Secondary headaches can be emergent because of intracranial pressure, infection, or disturbance of homeostasis (Hainer & Matheson, 2013). Sudden onset of headaches and the patient describing the headache as “the worst headache they have ever had” require immediate attention for potential life-threatening causes such as subarachnoid hemorrhage, post lumbar puncture dissection or TIA’s (Dunphy, Windland-Brown, Porter, & Thomas, 2015). MN568 Headaches Essay.
The pathophysiology of headaches is poorly understood. Migraine headaches are believed to be caused by a neurological dysfunction with involvement of the cranial nerves (Ferri, 2018). Not every patient with migraine headaches have been found to also have a neurological dysfunction. Migraine headaches are also believed to have a genetic disposition with an instability of the nervous system; specifically, with serotonin and neurotransmitters (Diener, Holle, Solbach, & Charly, 2016). Migraine headaches are often debilitating to patients. Patients with migraine headaches can experience photophobia, nausea, vomiting and an aura.
Patients with cluster headaches are believed to have an overactive parasympathetic nervous system (Hainer & Matheson, 2013). The headache causes mild-moderate pain and pressure. Hainer and Matheson (2013) describe tension headaches as pericranial myofascial tissues as the likely cause of these headaches. MN568 Headaches Essay.
Cluster headaches are commonly rare and involve brief episodes of severe pain that is unilateral and disturbance of routine activities of daily living. The headache involves a short duration of severe pain. Dunphy et al. (2015) describe triggers of these painful headaches caused by hypersensitized ophthalmic nerve (Dunphy et al., 2015).
Cluster headaches are episodic and short duration. MN568 Headaches Essay. The pain is severe and often does not last longer than an hour. The headaches are often misdiagnosed within one year of the first episode (Hainer & Matheson, 2013). The pain of these headaches is deep and may involve the eyes and nose. The patient may experience tearing or nasal congestion.
Acute headaches are an onset of a severe headache and can be classified as a red flag. Red flag headaches or primary headaches present related to an emergent underlying condition. This type of headaches is often described as the worst headache the patient has ever had MN568 Headaches Essay. A patient who reports this type of headache, especially in the age group of fifty and older are red flags for intracranial hemorrhage, hypertensive emergencies, or potential carotid dissections (Hainer & Matheson, 2013). Acute headaches could also be caused by meningitis, head trauma, or cancerous tumors.
Chronic headaches are daily tension-type headaches or migraine headaches. The headaches can be hormonal related in nature. Common trigger of a migraine headache may include: hormones such as low estrogen, disturbance in sleep cycle, food/drink agents such as caffeine, artificial sweeteners, processed or canned foods (Dunphy et al., 2015).
The nurse practitioner can assist in the determination of an old versus new headache by questioning the patient of the duration and frequency of the headache. Hainer and Matheson (2013) describe criteria of duration and frequency of primary headaches as a migraine is a headache that last of four to seventy-two hours, a cluster headache is brief with a fifteen to one hundred eighty-minute episode that occur numerous with a period of relapse (Hainer & Matheson, 2013). The nurse practitioner should ask specific questioning of duration and frequency of the patients headache for subjective data collection MN568 Headaches Essay.
Hainer and Matheson (2013) describe subjective data that would be a red flag symptom includes: complaints of a sudden severe headache, headache triggers with exertion or cough, neurological symptoms, new onset of headache during or after pregnancy, and complaints of neck stiffness (Hainer & Matheson, 2013).
The collection of an open-ended history and focused questions will assist the nurse practitioner in determining if the headache is primary or secondary. If the headache is primary focused questions will lead diagnostics of a migraine, tension, cluster or other headache MN568 Headaches Essay. A physical assessment with concentration on the neurological system and laboratory tests are essential before a final diagnosis. The physical exam should include assessment of the neurological system and cranial nerves II-X An assessment of the patient’s head and neck in attempts to mimic the pain is important. The physical assessment should be focused to alleviate muscular and skeletal disorders.
It is important for the nurse practitioner to obtain vital subjective data from the patient and complete a thorough physical assessment to distinguish between benign and headaches that require urgent attention. MN568 Headaches Essay.
Red flags through patient data collection and physical assessment that require urgent attention include complaints of a sudden onset of a severe headache, papilledema, altered mental status, high fever, muscle rigidity, nuchal rigidity, and symptoms of a CVA, or TIA (Dunphy et al., 2015).
Evidence-Based Treatment Plan
Diagnostic testing for a definite diagnosis should include a comprehensive blood panel, with electrolytes. Consideration should be taken to check the female patient’s hormone level, thyroid levels and urinalysis to rule out infection. The patient should have a computed tomography (CT) scan with or without contrast completed to the brain to rule out any abnormalities and diagnosis of secondary headaches, or a magnetic resonance imaging (MRI).
Secondary headaches are treated mainly with over-the-counter analgesics. Evidence-based treatment for non-responsive conservative and over-the-counter treatment supports six classifications of medications: beta blockers, antidepressants, calcium channel blockers, antiepileptic, anticonvulsants, and nonsteroidal anti-inflammatory medications (Ferri, 2018). MN568 Headaches Essay.
Management of headaches is patient-centered. Headaches can be managed with drug therapy. Patient education should include the proper use of the drug therapy and over-the-counter analgesics. Patients should be encouraged to participate in stress relieving activities such as meditation or physical activity that does not aggravate a headache. Complementary therapy such as acupuncture, herbal therapy, and plenty of sleep should be encouraged by the nurse practitioner (Dunphy et al., 2015). MN568 Headaches Essay. The nurse practitioner should encourage the patient to drink plenty of fluids, and to eat a healthy diet rich in vitamin C foods.
Headache management should always be closely monitored and follow-up from the nurse practitioner is essential. Treatment plans should be closely monitored for the effectiveness of drug therapy, and potential referral to a specialist for the management of the headaches. MN568 Headaches Essay.
Diener, H. C., Holle, D., Solbach, K., & Charly, G. (2016). Medication-overuse headache: risk
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Dunphy, L. M., Winland-Brown, J. E., Porter, B. O. & Thomas, D. J. (2015) Primary Care: The
Art and Science of Advanced Practice Nursing. Philadelphia, PA: F. A. Davis Company.
Ferri, F. (2018). Ferri’s Clinical Advisor 2018: 5 books in 1. Philadelphia, PA: Elsevier.
Hanier, B. L., & Matheson, E. M. (2013). Approach to Acute Headaches in Adults. American
Family Physician, 15(87), 682-687. MN568 Headaches Essay.