13.2 Plan Nutritional Strategies to Impact Pulmonary Wellness

Migraine headaches are complex neurological disorders involving the trigeminovascular system. They're characterized by phases of symptoms, from prodrome to postdrome, with triggers ranging from stress to dietary factors. Understanding these mechanisms is crucial for effective management.

Pharmacological treatment of migraines includes preventive and acute medications. Triptans and ergotamines are key players in acute treatment, working on serotonin receptors to relieve symptoms. Each drug class has specific side effects and contraindications that nurses must consider when administering treatment.

Pathophysiology and Symptoms of Migraine Headaches

Mechanisms of migraine headaches

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• Neurological disorder involving the trigeminovascular system
  • Trigeminal nerve innervates the meninges and cerebral blood vessels
  • Activation of trigeminal nerve releases vasoactive peptides (CGRP, substance P) causing vasodilation and neurogenic inflammation
• Cortical spreading depression (CSD) wave of neuronal and glial depolarization followed by suppression of neural activity associated with aura symptoms and activation of trigeminal nerve
• Serotonergic dysfunction: imbalance in serotonin levels may contribute to migraine pathogenesis by increasing pain sensitivity and vasodilation

Triggers and symptoms of migraines

• Common triggers include stress and anxiety, hormonal changes (menstrual cycle, menopause), sleep disturbances (insomnia, oversleeping), dietary factors (alcohol, caffeine, certain foods), and environmental factors (bright lights, loud noises, strong odors)
• Symptoms occur in phases:
  • Prodrome (hours to days before headache) characterized by fatigue, mood changes, food cravings, neck stiffness
  • Aura (occurs in some patients, usually before headache) involves visual disturbances (flashing lights, blind spots), sensory disturbances (tingling, numbness), and language disturbances (difficulty speaking)
  • Headache phase presents with unilateral, pulsating pain of moderate to severe intensity aggravated by physical activity along with nausea, vomiting, photophobia, and phonophobia
  • Postdrome (after headache resolves) characterized by fatigue, cognitive difficulties, mood changes

Pharmacological Management of Migraine Headaches

Classes of migraine medications

• Preventive medications (prophylaxis) taken regularly to reduce frequency and severity of migraines include beta-blockers (propranolol, metoprolol), antidepressants (amitriptyline, venlafaxine), anticonvulsants (topiramate, valproic acid), and CGRP antagonists (erenumab, fremanezumab)
• Acute treatment medications (abortive therapy) taken at the onset of a migraine to relieve symptoms include triptans (sumatriptan, rizatriptan), ergotamines (ergotamine, dihydroergotamine), NSAIDs (ibuprofen, naproxen), and combination analgesics (acetaminophen/aspirin/caffeine)

Pharmacology of triptans vs ergotamines

• Triptans are selective serotonin (5-HT) receptor agonists primarily targeting 5-HT1B and 5-HT1D receptors causing vasoconstriction of dilated cranial blood vessels, inhibition of vasoactive peptide release (CGRP, substance P), reduction of neurogenic inflammation and pain transmission
• Ergotamines are nonselective serotonin receptor agonists with affinity for 5-HT1B, 5-HT1D, and 5-HT1F receptors causing vasoconstriction of cranial blood vessels, inhibition of trigeminal nerve activation and pain transmission, and reduction of neurogenic inflammation

Side effects of migraine drugs

• Triptans side effects include paresthesia, chest tightness, fatigue, dizziness, nausea and are contraindicated in patients with cardiovascular disease, uncontrolled hypertension, or hemiplegic migraine with drug interactions involving MAO inhibitors, ergotamines, SSRIs, SNRIs
• Ergotamines side effects include nausea, vomiting, abdominal pain, muscle cramps, paresthesia and are contraindicated in patients with cardiovascular disease, uncontrolled hypertension, or pregnancy with drug interactions involving triptans, macrolide antibiotics, protease inhibitors
• Beta-blockers side effects include fatigue, dizziness, hypotension, bradycardia, sexual dysfunction and are contraindicated in patients with asthma, heart block, or severe peripheral vascular disease with drug interactions involving calcium channel blockers, antiarrhythmics, insulin
• Anticonvulsants side effects include drowsiness, dizziness, weight changes, cognitive impairment with drug interactions involving oral contraceptives, valproic acid, carbamazepine

Nursing considerations for migraine treatment

• Assessment involves obtaining a thorough headache history including triggers, frequency, severity and assessing for contraindications and drug interactions before administering medications
• Administration ensures proper dosing and route of administration for each medication and educates patients on the proper use of acute treatment medications (take at onset of migraine)
• Monitoring assesses for effectiveness of treatment and any adverse effects and monitors vital signs, especially in patients taking ergotamines or triptans
• Patient education teaches patients about the importance of avoiding triggers and maintaining a healthy lifestyle and instructs patients on the proper use, storage, and disposal of medications while encouraging patients to keep a headache diary to track triggers, symptoms, and treatment effectiveness

Patient education for migraine management

• Lifestyle modifications include stress management techniques (relaxation, meditation, exercise), maintaining a regular sleep schedule, avoiding known triggers (certain foods, alcohol, caffeine), staying hydrated and eating a balanced diet
• Proper use of medications involves taking preventive medications as prescribed even when feeling well, using acute treatment medications at the onset of a migraine not exceeding recommended dosage, and avoiding medication overuse which can lead to rebound headaches
• Tracking migraines and treatment effectiveness by keeping a headache diary to record triggers, symptoms, and response to medications and sharing the diary with healthcare providers to optimize treatment plan
• Follow-up care schedules regular check-ups with healthcare providers to monitor progress and adjust treatment as needed and reports any adverse effects or changes in migraine patterns to healthcare providers
• Support and resources include joining a migraine support group or seeking counseling to cope with the impact of migraines on daily life and utilizing reputable online resources (American Migraine Foundation, National Headache Foundation) for additional information and support