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03.09 Tension and Cluster Headaches

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Overview

  1. Tension Headaches
    1. Caused by stress or contracted muscles
    2. Tight pain in the head
    3. Are episodic or chronic
  2. Cluster Headaches
    1. Unknown exact cause -> thought to be histamine release and/or vasoconstriction and sudden vasodilation
    2. Sharp pain in the head
    3. Are episodic or chronic

Nursing Points

General

  1. Tension Headaches
    1. Episodic
      1. Caused by stress
      2. Moderate
    2. Chronic
      1. Caused by contracted muscles of neck and scalp
      2. Occur daily
    3. Risk factors
      1. Stress
      2. Poor posture
      3. Anxiety and/or depression
  2. Cluster Headaches
    1. Associated with histamine release and/or vasodilation of vessels
    2. Episodic
      1. 2 phases that last 7 days to 1 year
      2. Remission 1 month or longer
    3. Chronic
      1. Occur more than once a year
      2. Remission less than 1 month
    4. Risk factors
      1. Males
      2. Smoking
      3. Alcohol consumption

Assessment

  1. Presentation
    1. Tension
      1. Frontal-occipital tightening pain
      2. Sensitivity to light
      3. Sensitivity to sound
    2. Cluster
      1. Stabbing pain in temporal or periorbital regions
      2. Agitation and restlessness
      3. Accompanied by allergy symptoms
        1. Nasal stuffiness
        2. Eyelid swelling

Therapeutic Management

  1. Tension Headaches
    1. Medications for pain
      1. Analgesics
      2. NSAIDs
    2. Lifestyle changes
      1. Improve posture
      2. Exercise and stretching
      3. Adjust sleep schedule
      4. Manage stress
  2. Cluster Headaches
    1. Medications
      1. Prevention
        1. Antihistamines
        2. Calcium channel blockers -> less calcium = relaxed smooth muscles = dilated arteries
      2. Treatment
        1. Ergotamine drugs -> stimulate serotonin, norepinephrine, and dopamine receptors causing constriction
        2. Anesthetics
        3. SSRIs -> stimulate serotonin receptors causing constriction
    2. Lifestyle changes
      1. Stop drinking
      2. Stop smoking
      3. Manage stress

Nursing Concepts

  1. Intracranial Regulation -> chemicals causing dilation and inflammation
  2. Pharmacology -> medications to treat/prevent
  3. Patient Education -> lifestyle changes to prevent headaches an avoid triggers

Patient Education

  1. Manage stress
  2. Stop smoking
  3. Stop drinking alcohol
  4. Monitor triggers
  5. Exercise

Reference Links

Study Tools

Video Transcript

Hey guys! In this lesson we will discuss tension and cluster headaches. 

In this lesson on tension and cluster headaches, we will cover what they are, why they occur, and how they are treated. Let’s begin with tension headaches.

Tension headaches consist of tight pain in the head that is caused by stress or contracted muscles. They may be episodic which are caused by stress and there are periods of time in between headaches. They may also be chronic and occur daily, which are typically caused by contracted muscles of the neck and scalp. Risk factors for tension headaches include stress, poor posture, anxiety or depression. Next, let’s look at cluster headaches. 

Cluster headaches consist of a sharp pain in the head. The exact cause is unknown, but they are thought to occur because of histamine release and/or constriction with sudden vasodilation. Cluster headaches are either episodic or chronic. Episodic cluster headaches occur in two phases that last from seven days up to one year with a remission of at least one month between. Chronic cluster headaches occur more than once a year and the remission time in between episodes is less than one month long. Risks factors for these headaches include being male, smoking, and consuming alcohol. Next, let’s look at how these patients present during assessment. 

A person with a tension headache experiences tightening pain in the frontal-occipital area. They typically are sensitive to light and sound, causing them to seek out dark, quiet rooms to rest. 

A person with person with a tension headache experiences tightening pain in the frontal-occipital area. They typically are sensitive to light and sound, causing them to seek out dark, quiet rooms to rest. 

 cluster headaches has stabbing pain in their temporal or periorbital regions. They typically appear agitated or restless, rather than resting in bed. They often have allergy symptoms such as nasal stuffiness or eyelid swelling because of the increased histamine. Now let’s move on to management of these headaches.

Tension headaches can be managed with medications for pain and lifestyle changes. Medication that may be used include analgesics or NSAIDs. Lifestyle changes include improving posture, exercising and stretching, adjusting sleep schedules, and managing stress. You know in nursing school you get headaches because you are leaning over the books studying and hunched over your computer. You probably aren’t getting enough exercise or sleep and are super stressed, so changing these lifestyle concerns can help fix that.

Cluster headaches are managed with medications to treat or prevent them and lifestyle changes. Lifestyle changes include avoiding drinking alcohol and smoking, and managing stress. Let’s discuss the different medications that the doctor may prescribe.

Antihistamines may be given to prevent the release of histamine in the body that is thought to cause cluster headaches. Calcium channel blockers prevent calcium from contracting smooth muscles which results in dilated arteries to prevent the initial constriction. Ergotamine drugs stimulate serotonin, norepinephrine, and dopamine receptors causing vasoconstriction to prevent the sudden vasodilation. Anesthetics are sometimes given to control the pain. SSRIs stimulate serotonin receptors causing constriction.

It’s important to educate your patients with headaches on different things they can do to prevent them. They should work on managing their stress, stop smoking, stop drinking alcohol, and exercise. They can monitor for triggers that set off their headaches so that they may be avoided in the future.

The priority nursing concepts for the patient with tension and cluster headaches include intracranial regulation, pharmacology, and patient education.

Alright, now let’s review the key points. Tension headaches consist of tight pain in the head that is caused by stress or contracted muscles in the head and neck. Cluster headaches consist of sharp pain in the head that is thought to be caused by histamine release and/or constriction of the vessels in the brain with sudden dilation after. Treatment for both types of headaches include lifestyle changes such as managing stress and avoiding alcohol and smoking. Medications for tension headaches target pain, whereas medications for cluster headaches target the histamine release, vasoconstriction, or vasodilation to prevent or treat the headache. Our patients should be educated to work on stress management, stop smoking and drinking, monitor triggers, and exercise.

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

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