WEEK 5 : Pharmacotherapy of Neurological Disorders
Multiple disorders are incorporated into the heading neurological disorders, headaches, seizures, depression, and dementia are just a few. Headaches are a commonly encountered complaint in primary care practice.
Headaches are categorized as primary with no underlying causes and secondary with known underlying etiology. Primary headaches include migraine, tension-type, trigeminal autonomic cephalalgias, cluster headaches, and other primary disorders. Secondary headaches are attributed to disease processes, such as traumatic brain injury, substance withdrawal, cerebrovascular disorders, and other disorders. Each headache is individualized and experienced individually by the patient. Advance practice nurses must review symptoms, occurrence details, triggers, duration and frequency of headaches, current treatments, location of pain, and intensity. Details allow for specific diagnosis of the type of headaches leading to effective treatment.
Treatment
Multiple treatments are available for mild, moderate, and severe headaches. Goals of therapy include a reduction in frequency, severity while improving quality of life and functionality. First line treatment of mild to moderate primary tension headaches include acetaminophen, aspirin, and NSAIDS. However, these treatments must be monitored and altered for any patients with renal or liver disease or insufficiency and are to be used episodic less than 2 times per week. Second line treatment for tension type headaches include antiemetics, over the counter combination agents, such as Excedrin, and prescription butalbital/caffeine/acetaminophen medication. All headache remedies should be used infrequently to decrease the chance of medication overuse headache.
Migraine headaches are diagnosed as recurrent headaches lasting 4 – 72 hours and severe pain leading to functional limitations. Migraines can be triggered from food to hormones to lack of sleep and onset is quick pulsating with or without auras. Pathophysiology of migraines is not fully understood and is influenced by multiple factors. Treatment goals are the same for migraines as tension headaches.NURS 6521 Advanced Pharmacology Discussion First line treatment begins with NSAIDS and aspirin for acute attack treatment. Acute attacks can also be treated with over the counter medications, such as Excedrin. 2nd line for recurrent migraines not responsive to first line treatment includes triptans. Triptans, or 5-HT Receptor Agonists, work on intracranial blood flow, sensory neurons, and trigeminal terminals to decrease the symptoms of migraine. Each triptan has individual onsets, duration’s, and half-lives. Ergot derivatives, barbiturates, opioids, and steroids are also options for acute attack treatment. Prophylactic treatment is initiated to prevent to occurrence frequency and severity of migraines when patients experience more than 2 headaches a week and quality of life/functioning is altered (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Treatment with anticonvulsants, ACE, ARBs, beta blockers, triptans, CCBs, and antidepressants have all been shown to assist in migraine prevention. Prophylactic treatment must be individualized and based on efficacy and tolerance by the patient, it may take different therapies for each patient. Headache treatment can be difficult and problematic as a generalized treatment plan will not be sufficient to treat every patient (Affaitati, Martelletti, Lopopolo, et. al., 2017).
Genetics
Headaches, such as migraines and other types have been linked to familial occurrence and hereditary. A study from China in the journal, Clinical Neurology and Neurosurgery, demonstrated high prevalence of headaches in comparison with the general population making familial ties a very influential factor aiding in diagnosis (He, Yu, Liu, Yang, et. al., 2016) Advance practice nurses should review family history as well as medical history when evaluating a patient for recurrent headaches seeking treatment.
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