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Headaches The most common type of pain that people have -Primary -…

- - - - Risk Factors:
        -Family History
        -Age, female gender
        -Obesity
        -Low Level Education
        -Depression
        -
        
        Drug Therapy:
        MILD TO MODERATE: NSAID, Aspirin, Caffeine containing analgesics
        MODERATE TO SEVERE: Triptan Drugs
        Toperimate - ANTISEIZURE drug to PREVENT migraines
        BetaBlocker for prevention
        Botulinum toxin A (Botox) - used for prevention if any other medication does not work or pt has migraines for 15 days out of the month. Effective up to 6 months at a time
  - - - Clinical Manifestations:
        Short stabbing pain
        Pain is usually around the eye, radiating to the temple, forehead, cheek, nose, or gums.
    - - Diagnostic Tests:
        -Based on patient history
        -Ask patient to keep diary
        
        Inter professional Care:-
        -Triptans are standard treatment for occasional cluster headache
        -High flow of 100% O2 by non-re breather mask is well-tolerated, safe and effective as an ALTERNATIVE TREATMENT
        -Preventative treatment: High-dose Verapamil is the first drug of choice.
        Careful monitor is needed during this drug treatment. An ECG should be done with every dose increase and every 6 months during treatment for patient safety.
  - - - Diagnostic Studies:
        -Careful history taking may be the most useful tool for diagnosing TTH
        
        Drug Therapy:
        Anti Depressants - decrease occurrences.
        -Tricyclic agents
        -Non adrenergic sertonergic antidepressant
        Anti seizure drugs - topiramate or divalproex
        Muscle Relaxation Training
        Psychotherapy
        -Massage and moist hot packs to the neck and head can help
        
        Tricyclic Agents: -Amitriptyline -Nortriptyline
        
        Nonadrenergic Serotoneric antidepressant: -Mirtazapine(Remeron)
        Venlafaxine (Effexor XR)
- - - - Planning:
        Goals are to
        1.) have reduced or no pain
        2.) Understand triggering events and treatments
        3.) Use positive coping strats to deal with pain
        4.) Have increase quality of life and decreased disability
        
        Implementation:
        -Help the patient examine daily routine, stressful situations, and develop effective coping strategies.
        -Help the patient identify precipating factors and develop ways to avoid or minimize them.
        -Encourage daily exercise, relaxation periods, and socialization as ways to decrease headaches
        -Suggest medication, relaxation, yoga, and other ways to address headache pain
        
        Evaluation:
        Expected outcomes are that the patient with headaches will
        -Report satisfaction with pain management
        -Use Drug and non drug measures appropriately to manage pain