Migraine—This type of headache is characterized by a paroxysmal attack often preceded by psychologic or visual disturbance that is followed by drowsiness. Women are affected more often than men. Migraine headaches are believed to be the result of vascular changes.
SYMPTOMS—There is usually a throbbing sensation or pain resulting from vasoconstriction followed by dilation. The patient often experiences nausea and vomiting. Often there is a family history of migraines, and the frequency of attacks may vary from daily to once every few years. The pain is usually unilateral and may last for 2 or 3 days.
TREATMENT—Cafergot® is the most widely used drug in the treatment of migraines. It should be administered at the first sign of headache (provided a history of migraine is obtained or you have actually diagnosed it). Place the patient on bed rest for a few hours in a darkened room and withhold any food or drink. At times the pain is so severe that narcotics maybe necessary for pain; Demerol is the drug of choice. Codeine is contraindicated.
Cluster—There is usually no clear history of headaches in the patient’s family. Middle-aged males are most often affected, and the headaches may be precipitated by the use of vasodilators, alcohol, or histamine.
SYMPTOMS—The onset is sudden and is characterized by severe unilateral pain that may disappear after 1 or 2 hours as rapidly as it came. Nocturnal attacks are common, and the patient may have associated symptoms such as redness and lacrimation of the eyes, rhinorrhea, and nasal congestion.
TREATMENT—The pain of this headache is so severe that the patient should be kept on bed rest until the pain ceases. Administer Sansert ® (methysergide maleate) to help prevent cluster headaches from becoming vascular headaches. Cluster headaches are so severe and of such short duration that adequate therapy is difficult; however, administering antihistamines may be effective.
Hypertensive—Normally these headaches are the result of chronic hypertension. They are characterized by a persistent bilateral throbbing pain. The best treatment is to control the patient’s hypertension. The patient may be helped by analgesics, understanding, and reassurance.
Epilepsy
This is a convulsive disorder that is characterized by abrupt transient symptoms of a motor, sensory, psychic, or autonomic nature. Attacks are usually accompanied by altered levels of consciousness, and there is usually a history of epilepsy in the patient’s family. The onset of epilepsy is usually before the age of 30. There are several types of epileptic seizure classifications. The three major classifications are generalized, partial, and unclassifiable epilepsies. The generalized epilepsies are the most commonly encountered and include the petit mal and grand mal types.
Grand Mal Seizures—These are divided into the following two groups.
Jacksonian Seizure—This type of seizure is characterized by an aura, often referred to as a warning, but which in reality is a part of the seizure. The patient will experience convulsions without lapsing into unconsciousness. The seizure may start in the toes or thumbs or in the face (the eyes and head may turn to one side), and the seizure may then spread to other areas.
Typical Grand Mal Seizure—This type of seizure may have the initial aura as described above. The patient may fall down and cry out, lose bladder and bowel control, and froth at the mouth. There is convulsive movement of the body, dyspnea, and cyanosis. Corneal reflexes are usually absent and Babinski’s reflex is positive. Often the patient bites the tongue and, if not completely unconscious, will be confused and disoriented. The seizure usually lasts 2 to 5 minutes. A period of deep sleep is common after the seizure, and the patient will complain of muscle soreness and stiffness upon awakening.
TREATMENT—Immediate treatment is aimed at preventing the patient from injuring himself or herself. A tongue depressor or other type of padded gag should be placed between the patient’s teeth to prevent biting the tongue; however, this may not be possible if the jaws are clenched. Don’t force it. Never try to restrain a patient during convulsions; however, do not leave the patient alone. Loosen the clothing around the neck, and turn the head to the side to prevent
