Headaches are a common neurological disorder that can have significant physical and emotional implications for patients of all ages. They can impact judgment, school or job performance, and relationships with family and friends (Arcangelo et al., 2017). Headaches can vary in intensity, duration, and location, with pain occurring in any region of the head. Primary headaches, such as tension-type headaches (TTH) and migraines, are not associated with any underlying organic disease process, while secondary headaches have a specific identified cause (American Psychiatric Association, 2013).
To effectively manage recurring headaches, it is important to determine the underlying cause. In some cases, headaches may be symptomatic of another disease or condition, while in others, no clear cause can be identified (Drugs.com, 2017). Over-the-counter pain relievers like aspirin, Aleve, Tylenol, or Advil can be helpful for most tension headaches (Drugs.com, 2017). For episodic TTHs, simple analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are recommended (AMA, 2017). However, caution should be exercised with analgesic/caffeine drugs due to the risk of rebound headaches with frequent use (AMA, 2017). Preventive medications for migraines may include antidepressants like amitriptyline or fluoxetine (AMA, 2017).
NURS 6521 Week 5: Headaches and their Management
NSAIDs are used for acute treatment during vulnerability periods, while other medications like beta blockers, tricyclic antidepressants (TCAs), Depakote, triptans, ergot derivatives, barbiturates, steroids, and opioids may be employed based on individual needs (AMA, 2017). It is important to rule out overmedicating headaches by temporarily withholding all analgesics for one to two weeks (Arcangelo et al., 2017).
Gender differences exist in the prevalence and characteristics of headaches. Migraines are more commonly seen in females, especially those with a family history, while cluster headaches are more prevalent in males. Tension headaches are twice as common in females compared to males, often associated with stress and sleep deprivation (Arcangelo et al., 2017). Research studies have demonstrated that women tend to develop headaches at an earlier age than men and may be more prone to depression and self-harm behaviors (Lisotto et al., 2013; Rozen & Fishman, 2012). NURS 6521 Week 5: Headaches and their Management
To minimize negative side effects, close monitoring of headaches is necessary to prevent further complications. Physicians may need to adjust medications by reducing, increasing, combining, or eliminating them based on assessment and treatment follow-up. Complementary measures such as vitamin supplements, relaxation therapy, and massage can be considered alongside pharmacologic therapy to manage headaches effectively and avoid potential side effects (Arcangelo et al., 2017).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
American Migraine Association (AMA). (2017). Tension-type headache (TTH). Retrieved from: https://americanmigrainefoundation.org/understanding-migraine/tension-type-headache/
Drugs.com. (2017). Selective serotonin reuptake inhibitors. Retrieved from: https://www.drugs.com/drug-class/ssri-antidepressants.html
Lisotto, C., Mainardi, F., Maggioni, F., & Zanchin, G. (2013). The prevalence of cluster headache in the elderly is higher in women than men. Journal of the Neurological Sciences, 333(1), 496. doi:10.1016/j.jns.2013.07.1756
Rozen, T., & Fishman, R. (2012). Female cluster headache in the United States of America: What are the gender differences?: Results from the United States cluster headache survey. Journal of the Neurological Sciences, 317(1-2), 17-28. doi:10.1016/j.jns.2012.03.006