03.08 Migraines

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Outline

Overview

  1. Migraine
    1. Chronic condition involving arteries in the brain -> vasoconstriction and sudden dilation = severe headache
    2. Many triggers
    3. Treated with rest and medications

Nursing Points

General

  1. Chronic condition involving arteries in the brain
    1. Vasoconstriction
    2. Sudden dilation
    3. Neuropeptides released by trigeminal nerve – > cause pain and inflammation
  2. Triggers
    1. Stress and/or lack of sleep
    2. Bright lights
    3. Loud sounds
    4. Medications
    5. Smoking
    6. Fasting
  3. Phases
    1. Prodome (before)
      1. Food cravings
      2. Mood changes
    2. Aura (before or during)
      1. Flashing lights
      2. Muscle weakness
    3. Headache (during)
    4. Postdrome (after)
      1. Fatigue
      2. Confusion
  4. Risk Factors
    1. Female
    2. Genetics
    3. Medical conditions
      1. Involving brain
      2. Involving blood vessels

Assessment

  1. Presentation
    1. Headache
      1. Throbbing
      2. Moderate or severe
    2. More painful when moving
    3. Nausea/vomiting
    4. Sensitive to light
    5. Sensitive to sound
  2. Doctors orders -> rule out other causes
    1. Lab tests
    2. CT scan
    3. MRI

Therapeutic Management

  1. Medications
    1. SSRIs ->stimute serotonin receptors causing constriction
    2. Ergotamine drugs -> stimulate serotonin, norepinephrine, and dopamine receptors
    3. Beta-blockers -> Block epinephrine to prevent initial vasoconstriction
    4. Calcium channel blockers -> less calcium = relaxed smooth muscles = dilated arteries
    5. Analgesics or NSAIDS-> treat pain
  2. Resting in a quiet, dark room
  3. Hydration

Nursing Concepts

  1. Intracranial Regulation -> chemicals causing vasoconstriction and sudden dilation
  2. Patient Education -> lifestyle changes to prevent migraines
  3. Pharmacology -> medications to treat/prevent

Patient Education

  1. Reduce stress
  2. Improve sleep schedule
  3. Stop smoking
  4. Do not fast

Transcript

Hey guys! In this lesson we will talk about migraines.

In this lesson on migraines, we will cover what migraines are, why they occur, and how they are treated.

A migraine is a chronic condition that involves the arteries in the brain. So what happens is the arteries are first constricted, but then suddenly dilate. Neuropeptides are released by the trigeminal nerve which causes pain and inflammation in the head. Next, let’s talk about migraine triggers.

There are many things that can trigger a migraine to occur. Lifestyle habits such as poor sleep, stress, smoking, or fasting can cause a migraine to occur. Environmental factors such as bright lights and loud sounds can trigger them as well. Certain medications may also be triggers. Next, let’s look at the different phases.

There are four phases to a migraine, however, not everyone will experience all of them. The prodome phase occurs before the migraine. This is where the person may experience food cravings or mood changes. The aura phase may occur before or during the migraine. During this phase, the person might see flashing lights or feel weak. Some people may or may not experience an aura, but they will be asked about it and this is what they are talking about. The headache phase is during the migraine where the patient experiences moderate to severe head pain. After the migraine, the patient may experience a postdrome phase where they feel very tired and sometimes even confused. Next, let’s discuss the risk factors.

There are certain factors that make a person more at risk for developing migraines, such as being female. Genetics have great influence on whether a person may have migraines. Medical conditions put a person more at risk, especially diseases that involve the brain or the blood vessels such as hypertension or cardiovascular disease.

A person with a migraine may present with many symptoms. They will have a throbbing headache that may be moderate or severe in pain. The headache may be more painful when they move around. The patient may experience nausea and/or vomiting. They will likely be very sensitive to light and sound. When a person experiences these symptoms, the doctor may complete lab tests, a CT scan, or an MRI to rule out other diseases that may be causing these symptoms.

The doctor may prescribe one or more of many different medications to treat migraines. SSRIs are used to stimulate serotonin receptors causing vasoconstriction in the arteries so that the sudden vasodilation does not occur to set off the migraine. Ergotamine drugs stimulate serotonin, norepinephrine, and dopamine receptors to prevent sudden dilation. Beta-blockers block epinephrine to prevent the initial vasoconstriction. Calcium channel blockers stop calcium from stimulating the smooth muscles around the arteries so that they may relax and dilate, preventing the initial vasoconstriction. Analgesics or NSAIDs may be given to treat pain caused by the headache. It’s also really helpful for these people to rest in a quiet, dark room and hydrate with fluids.

Guys, it’s super important to educate your patient on the lifestyle changes that they can make to prevent the migraines from occurring. Suggest that they find ways to manage their everyday stress and improve their sleep schedule. They should stop smoking to avoid damaging and constricting the vessels. Fasting should be avoided by eating small meals throughout the day.

Our nursing concepts for the patient with migraines include intracranial regulation, patient educations, and pharmacology.

Let’s review the key points on migraines. Migraines are caused by the vasoconstriction and then sudden dilation of the arteries in the brain. Symptoms include moderate to severe headaches, sensitivity to light or sound, and nausea or vomiting. The phases that the person may experience include prodome, aura, headache, and postdrome. Migraines may be treated with pain medications or prevented by providing drugs that prevent the initial vasoconstriction or sudden dilation of the vessels. It’s important to educate our patients on lifestyle changes to prevent migraines, such as smoking cessation, reducing stress, and improving sleep.

 

We love you guys! Go out and be your best self today! And as always, Happy Nursing!