NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Headaches “Cephalalgia”
Primary Headache
★ Not associated with other underlying causes, no patho
Patho Etiology Manifestations
Tension HA
Episodic: Common -Jaw Clenching -Common location:
● 10-15 days per month anatomical & -TMJ frontal and temporal
● Last from 30 mins to physiological -Degenerative -Arthritis -Generally bilateral
days mechanism: of neck -Occipital, either one or
trigeminocervical both sides
complex
Chronic: Contractions of -Work/exercise -Pain is mild to mod
● Occurring more than muscles in neck, -Poor posture -Described as constant
15 days/month over a face, scalp, jaw -Lack of sleep pressure to face, head,
3-month period -Sleep apnea neck
● Generally more severe -Missed meals -Sensitivity to light
than episodic -Depression -Scalp soreness
-Anxiety -AM HAs
-Forceful/intense
Migraine HA
● Frequent in the AM, Unknown, possible Triggers: -Pulsating/throb
upon awakening vasodilation= pain -Change in weather -May associate with
● Predictable times environment neuro signs like motor
(menstruation) -Strong odors weakness, language
-Tobacco disturbances, pupillary
-Motion sickness changes
-Hypoglycemia -Double vision or floaters
-Flashing lights
-Stress, no sleep
-Food: aspartame, wine,
aged cheeses, MSG,
caffeine & caffeine
withdrawal, processed
foods
Cluster HA
-Most severe form of primary Trigeminal -Cause is unclear -Sudden extreme pain
-Generally occur around the autonomic -Called Histamine -One side of the head,
same time for 4-8 weeks, (involuntary) Headaches but behind or around one eye
often at night cephalalgia treatment with -Agitation and
-Occur daily to near daily for antihistamine usually restlessness
weeks to months with long unsuccessful -Light sensitivity and
periods of remission sound
-Generally peak 5-10 mins -Alterations in HR/BP
after onset, continue in -Lacrimation
intensity for 1-3 hours -Stuffy, reddened nose
-More common in smokers -Ptosis (eyelid droop)
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Secondary Headache
★ Patho related: infection, tumors, vascular abnormality, medication-induced,
idiopathic
Patho
★ Trigeminocervical complex: network of neurons relaying pain signals from cervical
spine and from the meninges through the trigeminal nerve
Diagnostics
★ MRI or CT: rule out secondary causes
★ Use of Headache Diary
○ Patient is instructed to record the date and time of HA occurrence, activities,
foods and meds taken close to HA to determine possible triggers and see
patterns
Patient-Focused Management
★ Treatment of tension HA involves treating underlying causes
○ Depression and anxiety= counseling and antianxiety meds
○ PT for poor posture
○ Anti-inflammatories for arthritis
○ Corrective devices to help alleviate TMJ pain
★ Lifestyle Modifications
○ Identify food triggers and eliminate
○ Ensure regular meals + good hydration
○ Consistent sleep habits
○ Massage & gentle neck exercises to relieve tension
○ Stress reducing activities
★ Medication Overuse HA
○ Daily use of tylenol and motrin begins a cycle resulting in frequent HAs that
cannot be broken unless med is stopped
○ Sudden or gradual withdrawal is needed to correct the problem
Abortive Medications
★ Sumatriptan (Imitrex)
○ Five HT1 Agonist: vasoconstriction in large intracranial arteries
○ Instruct patient to administer med as soon as migraine symptoms appear-
NOT USED FOR PREVENTION
■ Notify pain or tightness in chest after use, dark room after admin, may
cause dizziness and drowsiness
○ Outcome: relief of acute migraine attack
★ Dihydroergotamine (Migranal)
○ Ergot Alkaloid: bind to serotonin receptors on nerve endings, decreasing pain
○ Use cautiously in illnesses associated with PVD such as DM, may cause MI
○ Take at first signs of HA, avoid smoking and EtOH
○ Outcome: constriction of dilated carotid artery bed= no vascular HA
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Preventative Medications
★ Lamotrigine & Gabapentin= anticonvulsants, increase the levels of many
neurotransmitters and diminish pain impulses
★ Propranolol= beta blocker and Amlodipine= calcium channel blocker: prevent
vasoconstriction or vasodilation in the cerebral blood vessels
★ Citalopram, paroxetine, escitalopram, fluoxetine= antidepressants, increases
serotonin and other chemicals in the brain, such as dopamine and norepinephrine
★ These meds are taken daily to prevent HAs, abortive meds are used as a rescue
when the HA occurs
Nursing Priorities
★ Assessment
○ VS, pain, triggers, abortive & preventative measures, auras
■ In patients who experience an aura in advance of the HA, abortive
interventions may be implemented earlier to decrease severity
★ Actions
○ Administer prescribed meds
○ Maintain calm, dark, quiet environment
★ Teaching
○ Importance of adequate sleep
○ Take pain medications as prescribed
○ Know food triggers
○ Headache Diary
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Brain Tumors
Gliomas
★ Originate in the cerebellum
★ Develop along the curved areas, making frontal lobes more at risk
★ Grade I & II are slow-growing
Meningiomas
★ Most common form of brain cancer between ages 40 and 70, more in females
★ 90% are benign, still can cause damage d/t being space-occupying lesions that can
increase ICP
Oligodendrogliomas
★ Main functions are to provide support and insulation to axons in the CNS
★ Slow-growing tumors that generally do not spread to surrounding tissue
○ Arising from fatty covering that protects nerves, generally occur in the
cerebrum
Acoustic Neuromas (CN VIII)
★ Slow-growing benign tumors that generally do not invade other tissue
★ Compression on other cranial nerves (CN V, VII, IX, X) and tissue (cerebellum &
brainstem) can manifest in severe complications
★ Originate from the protective covering around nerve fibers (CN VIII) at the
anatomical location of the cerebellopontine angle
Pituitary Tumors
★ Found in the anterior lobe, most common is adenoma, typically benign
Metastatic Tumors
★ Mechanism for cancer cells of a different primary cancer to invade the CNS is not
known
★ Some patients present with mets to the CNS at the same time that a primary cancer
is dx, while others present with CNS mets later in the course of their disease
★ Primary cancers such as lung cancer are typically a rapidly progressive type of
cancer, so it is common to diagnose mets during the initial presentation
UNIT 1: NEUROLOGICAL DISORDERS
Headaches “Cephalalgia”
Primary Headache
★ Not associated with other underlying causes, no patho
Patho Etiology Manifestations
Tension HA
Episodic: Common -Jaw Clenching -Common location:
● 10-15 days per month anatomical & -TMJ frontal and temporal
● Last from 30 mins to physiological -Degenerative -Arthritis -Generally bilateral
days mechanism: of neck -Occipital, either one or
trigeminocervical both sides
complex
Chronic: Contractions of -Work/exercise -Pain is mild to mod
● Occurring more than muscles in neck, -Poor posture -Described as constant
15 days/month over a face, scalp, jaw -Lack of sleep pressure to face, head,
3-month period -Sleep apnea neck
● Generally more severe -Missed meals -Sensitivity to light
than episodic -Depression -Scalp soreness
-Anxiety -AM HAs
-Forceful/intense
Migraine HA
● Frequent in the AM, Unknown, possible Triggers: -Pulsating/throb
upon awakening vasodilation= pain -Change in weather -May associate with
● Predictable times environment neuro signs like motor
(menstruation) -Strong odors weakness, language
-Tobacco disturbances, pupillary
-Motion sickness changes
-Hypoglycemia -Double vision or floaters
-Flashing lights
-Stress, no sleep
-Food: aspartame, wine,
aged cheeses, MSG,
caffeine & caffeine
withdrawal, processed
foods
Cluster HA
-Most severe form of primary Trigeminal -Cause is unclear -Sudden extreme pain
-Generally occur around the autonomic -Called Histamine -One side of the head,
same time for 4-8 weeks, (involuntary) Headaches but behind or around one eye
often at night cephalalgia treatment with -Agitation and
-Occur daily to near daily for antihistamine usually restlessness
weeks to months with long unsuccessful -Light sensitivity and
periods of remission sound
-Generally peak 5-10 mins -Alterations in HR/BP
after onset, continue in -Lacrimation
intensity for 1-3 hours -Stuffy, reddened nose
-More common in smokers -Ptosis (eyelid droop)
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Secondary Headache
★ Patho related: infection, tumors, vascular abnormality, medication-induced,
idiopathic
Patho
★ Trigeminocervical complex: network of neurons relaying pain signals from cervical
spine and from the meninges through the trigeminal nerve
Diagnostics
★ MRI or CT: rule out secondary causes
★ Use of Headache Diary
○ Patient is instructed to record the date and time of HA occurrence, activities,
foods and meds taken close to HA to determine possible triggers and see
patterns
Patient-Focused Management
★ Treatment of tension HA involves treating underlying causes
○ Depression and anxiety= counseling and antianxiety meds
○ PT for poor posture
○ Anti-inflammatories for arthritis
○ Corrective devices to help alleviate TMJ pain
★ Lifestyle Modifications
○ Identify food triggers and eliminate
○ Ensure regular meals + good hydration
○ Consistent sleep habits
○ Massage & gentle neck exercises to relieve tension
○ Stress reducing activities
★ Medication Overuse HA
○ Daily use of tylenol and motrin begins a cycle resulting in frequent HAs that
cannot be broken unless med is stopped
○ Sudden or gradual withdrawal is needed to correct the problem
Abortive Medications
★ Sumatriptan (Imitrex)
○ Five HT1 Agonist: vasoconstriction in large intracranial arteries
○ Instruct patient to administer med as soon as migraine symptoms appear-
NOT USED FOR PREVENTION
■ Notify pain or tightness in chest after use, dark room after admin, may
cause dizziness and drowsiness
○ Outcome: relief of acute migraine attack
★ Dihydroergotamine (Migranal)
○ Ergot Alkaloid: bind to serotonin receptors on nerve endings, decreasing pain
○ Use cautiously in illnesses associated with PVD such as DM, may cause MI
○ Take at first signs of HA, avoid smoking and EtOH
○ Outcome: constriction of dilated carotid artery bed= no vascular HA
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Preventative Medications
★ Lamotrigine & Gabapentin= anticonvulsants, increase the levels of many
neurotransmitters and diminish pain impulses
★ Propranolol= beta blocker and Amlodipine= calcium channel blocker: prevent
vasoconstriction or vasodilation in the cerebral blood vessels
★ Citalopram, paroxetine, escitalopram, fluoxetine= antidepressants, increases
serotonin and other chemicals in the brain, such as dopamine and norepinephrine
★ These meds are taken daily to prevent HAs, abortive meds are used as a rescue
when the HA occurs
Nursing Priorities
★ Assessment
○ VS, pain, triggers, abortive & preventative measures, auras
■ In patients who experience an aura in advance of the HA, abortive
interventions may be implemented earlier to decrease severity
★ Actions
○ Administer prescribed meds
○ Maintain calm, dark, quiet environment
★ Teaching
○ Importance of adequate sleep
○ Take pain medications as prescribed
○ Know food triggers
○ Headache Diary
, NUR 221
UNIT 1: NEUROLOGICAL DISORDERS
Brain Tumors
Gliomas
★ Originate in the cerebellum
★ Develop along the curved areas, making frontal lobes more at risk
★ Grade I & II are slow-growing
Meningiomas
★ Most common form of brain cancer between ages 40 and 70, more in females
★ 90% are benign, still can cause damage d/t being space-occupying lesions that can
increase ICP
Oligodendrogliomas
★ Main functions are to provide support and insulation to axons in the CNS
★ Slow-growing tumors that generally do not spread to surrounding tissue
○ Arising from fatty covering that protects nerves, generally occur in the
cerebrum
Acoustic Neuromas (CN VIII)
★ Slow-growing benign tumors that generally do not invade other tissue
★ Compression on other cranial nerves (CN V, VII, IX, X) and tissue (cerebellum &
brainstem) can manifest in severe complications
★ Originate from the protective covering around nerve fibers (CN VIII) at the
anatomical location of the cerebellopontine angle
Pituitary Tumors
★ Found in the anterior lobe, most common is adenoma, typically benign
Metastatic Tumors
★ Mechanism for cancer cells of a different primary cancer to invade the CNS is not
known
★ Some patients present with mets to the CNS at the same time that a primary cancer
is dx, while others present with CNS mets later in the course of their disease
★ Primary cancers such as lung cancer are typically a rapidly progressive type of
cancer, so it is common to diagnose mets during the initial presentation
