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- What Nurses KnowHeadaches - Wendy Cohan - Google книги
- Headaches & Migraines
They climb stairs, they make it worse. The pain itself then can be anywhere from mild to severe and so many patients might have mild migraine and don't seek a healthcare provider because it's not interfering enough. Tom Miller: What kinds of things should they be telling the practitioner? Should they take a history at home before they go see the practitioner about their headaches, or what should they do?
Susan Baggaley: That's always super-helpful. When did their headaches start? Did they start in childhood and increase - say for young women during their menstrual cycle - did it change with pregnancy? Did it change after somebody got a head injury, even though they never had headaches before that? Family history is incredibly important and oftentimes if a young child has a headache, and a parent of them had headaches, they know that this is probably a migraine.
But seeking healthcare advice is providing that history to the healthcare provider to say "I get a headache that makes me sick to my stomach. I miss work.
I have to lie down. The Excedrin kind of medication isn't working anymore. What do you have for me? Tom Miller: So, what about environmental triggers? I mean, I know physicians and practitioners generally will talk about the common myth is did you eat chocolate or do you get headaches when you drink red wine? Does that hold up under scrutiny? We know, actually that there are true physical triggers, environmental triggers. Perfumes, for instance can be a terrible trigger for somebody with migraine. So it's a reason for some people not to go to church and I give them a hall pass for that.
So, other times things like foods, so MSG, the aged cheeses, salami, bologna, things like that can actually increase the trigger for headache so one of the goals of a headache diary and treatment is to look and see-do they always get a headache after certain meals or drinks?
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Tom Miller: You mentioned the menstrual migraines and so certainly that's cyclical and women might be able to pick up on that. What about fasting? I've heard fasting might be a cause of migraine headache in some people.
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Susan Baggaley: Yes. There's an insulin gene associated with the migraine phenomenon and so oftentimes when you lower your blood sugar it's a trigger to a headache.
What we encourage in all of our patients is actually to eat every two hours, some form of lean protein with a carb not just car eating and clearly having to hydrate. As you know, in Utah we're the second driest state. We're at altitude. So other things that already predispose us to be dehydrated or dry is another component to headache and headache management. I always recommend it to my patients that a minimum of 84 ounces of water daily and then we take into consideration how much caffeine they may be drinking, whether hot or cold.
Tom Miller: Well, talk about caffeine. Is caffeine a trigger of headaches? I've heard in some situations maybe caffeine mitigates migraine. Susan Baggaley: It can. So, it's a very interesting phenomenon.
Many times when people use caffeine as a rescue agent for their headache, it can be helpful because caffeine actually medicines work better. That's why we have drugs like Excedrin Migraine and that actually has caffeine in it, to augment the aspirin and the Tylenol. However, too much caffeine can actually exacerbate the headache because it's a rebound phenomenon.
So, too much Susan Baggaley: That's true. I tell my patients I'm willing to go between 12 to 20 ounces of caffeine a day and usually not after 3: 00 p. Tom Miller: Now, what about alcohol? Now obviously if someone overindulges, they're going to have a headache, which is known as a hangover, in the morning. I'm not talking about that. I may be talking about someone who might take just a little bit of wine at a dinner party and then develop a headache.
Susan Baggaley: It's more common, Tom, with red wines, hopsy beers and just in general, some of the other straight liquors. So one of the rules of thumb I tell patients-if you have a drink, make sure you always have at least 12 ounces of water in between or after the first drink before you decide to have a second drink.
And again, hydration is key. Certain liquors can be less migraine-ogenic if you will, perpetuate a headache less frequently and soimes that's just be trial and error with the patient, to see. For instance, white wines that are sweeter-Goert's, De Meers, Rieslings tend to be more tolerated in the migraine population.
The red wines-merlots, cabernets - tend to be more offensive. So, subtle things like that that maybe a Shiraz may be more tolerated for red wine for a patient, may be a consideration.
I don't tend to have a big, long discussion in my practice about what drink to drink, but I think we should offer those pieces of information to our patients. Tom Miller: So, is there a headache that a patient should pick up on right away and then scurry to the emergency room?
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Are there certain types of headaches that you've got to get attention to pretty quickly and maybe you could describe that? Susan Baggaley: Absolutely. We call one headache a thunderclap headache that is probably the biggest risk of a new headache experience for a patient and that is literally what it's called. There are risk factors that are not changeable like genetics, for example. But others, such as stress, diet, or the overuse of medications, are much more easily changed through education. Other preventive strategies include following specialized diets and using mind-body techniques such as deep relaxation, visualization, and biofeedback to help people put an end to their headaches.
However, even if there is now more data linking migraine and ICH, the evidence is still too inconsistent to be used to predict the risk of ICH in people with migraine. Headache is a well-recognised symptom of stroke in general and occurs frequently in acute ischaemic stroke; numerous studies have examined the relationships between headache and factors such as stroke location, severity and aetiology.
Some even look at very specific causes of stroke, such as patent foramen ovale a hole in the heart , as a risk factor for headache Lantz et al, The figures reported in the literature mean that thousands of patients with stroke — especially those with haemorrhagic stroke — are at risk of headaches, whether after stroke, at stroke onset, or both. Post-stroke headaches are generally thought to be more common and more severe in patients who have had haemorrhagic stroke than in those who have had ischaemic stroke IHS, Fig 1 ; however, the actual evidence varies from study to study.
Despite this high incidence, there is still a lack of clear guidance, in stroke units, on how to prevent and treat post-stroke headaches. Also, little is known or understood about the true incidence and prevalence rates of headaches after ICH, as most of the published evidence seems to focus on ischaemic stroke Spector et al, Headache at stroke onset is a commonly reported but poorly described phenomenon.
Migraine studies have alluded to headaches being associated with the dilation of intracerebral arteries, particularly those at the base of the brain, so it would not be unreasonable to expect headaches to occur in stroke, where those arteries can be occluded or damaged. Harrison and Field acknowledge that the exact pathophysiology of headache after stroke is unclear. However, alongside the interruption of pain pathways resulting from stroke, it could be explained by blood vessel damage, alterations and inflammation.
Previously, bleeding in the brain after a haemorrhagic stroke was thought to stop within minutes of onset; however, advanced imaging techniques have shown the process is more complex, with bleeding continuing for several hours and potentially causing more swelling. That swelling can then cause a distortion of the brain structures and increase intracranial pressure Morgenstern et al, These patients commonly experience headaches both at stroke onset and after stroke. Vestergaard et al suggested that headache at stroke onset occurs in a quarter of patients with acute stroke.skomatinmeatring.cf
What Nurses KnowHeadaches - Wendy Cohan - Google книги
They reported no difference in headache rates between male and female recruits. A similar study by Klit et al reported Other studies have suggested that high rates of headache at stroke onset and after stroke are seen in haemorrhagic stroke, implying that it is more common than in ischaemic stroke. One of these studies Tendschert et al, reports that women are more likely to develop headache at stroke onset than men. Each year an estimated , people in the UK have a stroke.
Since the introduction of the National Stroke Strategy in Department of Health, , the stroke pathway has been significantly improved, bringing about better patient outcomes and fewer deaths.
Headaches & Migraines
More people survive stroke for longer, with an estimated 1. Stroke causes a vast array of disabilities not seen in other conditions and, despite improved management, it is still the third largest cause of disability in adults Stroke Association, As well as physical disabilities, patients may experience a number of hidden after-effects of stroke Box 3. Stroke is no longer a disease of older people and this needs to be recognised. One in six people who survive a stroke report that they have lost income. Not treating stroke-related headache or migraine compounds the difficulties of survivors in returning to work, therefore affecting them financially as well as physically and emotionally.