Tension-type headache
- Location-Bilateral, Over the top of the head, extending to neck
- Nature-varies from diffuse ache to tight, pressing, constricting pain
- Onset-gradual
- Duration hours to days
- Non-headache symptoms- scalp tenderness, neck pain and muscle pain
Migraine Headach
- Location-unilateral
- Nature- Throbbing; may be preceded by an aura
- Onset- Sudden
- Duration- hours to 2-3 days
- Non-headache symptoms- Nausea, vomiting
- Can be caused by a magnesium deficiency
- Menstrual migraines
Sinus Headache
- Location- face, forehead, or periorbital area
- Nature- pressure behind eyes or face; dull, bilateral pain
- Onset- simultaneous with sinus symptoms including purulent nasal discharge
- Duration- days (resolves with sinus)
- Non-headache symptoms- Nasal congestion
- Occur when infection or blockage of Para-nasal sinus causes inflammation
Medication over-use headaches
- Excessive use of analgesics, which is thought to cause change for episodic headaches to chronic headaches.
- This differs from headache occurring as adverse effects of meds such as nitrates and phosphodiesterase type-5 inhibitors
- Patient who suffer from migraines may use analgesic for relief but over time may increase their use of one or two drugs, resulting in the development of medication-overuse headache
- Associated with frequent use of medication (more than twice weekly for 3 months or longer)
- Onset occurs within hours of stopping the agent, and re-administration of the agent provides relief
- Nonprescription option of acetaminophen, aspirin, and other NSAIDs, and caffeine
- Prescription include triptans, opioids, butalbital, and ergotamine formulations
exclusions
- Last trimester of pregnancy
- <8 years of age
- High fever or sings of serious infection
- History of liver disease or consumption of 3 or >3 alcoholic drinks per day
- Headache associated with underlying pathology (secondary headache), except for minor sinus headache
- Symptoms consistent with migraine, but no formal diagnosis of migraine headache
- Non- Pharm
chronic tension (relaxation exercises, physical therapy)
migraine (regular schedule for eating
sleeping
eating and exercise
stress management
bio-feed-back; and cognitive therapy nutritional-
1) avoid trigger substances
2) avoidance of hunger and low blood glucose (trigger)
3) magnesium supplements
- Taking NSAID or salicylate at the onset of symptoms
can abort mild or moderate migraines
- Analgesic work best
- Analgesic work best in the early stages of a migraine
- Acetaminophen
o Analgesic and antipyretic
o Onset 30min
o Duration 4 hours and with extended release up to 6-8 hours
o FDA- fever and mild-moderate pain
o Live warning- adult take more thin 4000mg in 24 hours and child takes more 5 does in 24 hours, or takes it with other acetaminophen meds, or 3 or more alcoholic drinks daily
o Not with warfarin
o Older adults with mild to moderate pain
- Non-salicylate Non-steroidal Anti-inflammatory drugs (NSAID)
Adverse effects-dyspepsia, heartburn, nausea, anorexia, and epigastric pain
o Taken with full glass of water, shaken thoroughly, never crushed or chewed
o GI ulceration, perforation, and bleeding are serious potential complication of NSAID
o Risk factors- 60 or older, concurrent anticoagulant use (aspirin), high dose, or long duration of use, and 3 or more alcoholic drinks
o Associated risk of heart failure, stroke, hypertension, and myocardial infraction
o Inhibition depends on factors such as dose, serum level and half-life
- Salicylates (common aspirin)
o FDA- symptoms for osteoarthritis, rheumatoid arthritis, and rheumatologic disease, minor ache and pains
o Treating mild-moderate pain from musculoskeletal conditions and fevers
o Inhibitory effect is irreversible, example: inhibition continues for the duration of platelet’s life
o GI events, dyspepsia (minimize with food), gastritis and ulceration.
o Older then 15
o Do not give aspirin when pregnant
o Reye’s syndrome should not use
Reye’s syndrome
is acute illness occurring in children and teenagers, salicylates to treat viral illnesses associated with syndromes
• Reye’s syndrome: child and teens who have/are recovering form chicken pox or flue-like symptoms should not use this product. When using produce if N/V occurs, consult doc
- Combination products-
o Caffeine adjunct analgesics for tension-type and migraine headaches. But keep in mind caffeine can be a trigger for migraines and withdraw can result headache
-Aspirin vs. Nonacetylated Salicylates
-Aspirin vs. Nonacetylated Salicylates- aspirin superior analgesic and antipyretic
- Aspirin Vs. Acetaminophen-
- Aspirin Vs. Acetaminophen- equivalent analgesic efficacy, however acetaminophen may not be as effective in some types of pain in which inflammatory component is predominate.
- Aspirin vs. Non-salicylate NSAID-
- Aspirin vs. Non-salicylate NSAID- Ibuprofen to be least effective as aspirin treating pain, dental extraction pain, dysmenorrhea, and episiotomy pain. NSAIDs is better for inflammatory disorders (rheumatoid arthritis
NSAID vs. Acetaminophen-
- NSAID vs. Acetaminophen- episodic tension-type headache acetaminophen. Acetaminophen does not have anti-inflammatory properties
- Naproxen Vs. ibuprofen-
- Naproxen Vs. ibuprofen- similar except duration of naproxen is 8-12 hours while ibuprofen’s is 4-6 hours
three supplements
- Peppermint oil applied to oil applied to forehead and temples for tension headaches
- Magnesium for prevention of migraine headaches
- Acupuncture to prevent migraines an tension-type headaches
