Headache: Headache is pain in any region of the head. It may occur on one or both sides of the head, be isolated to a certain location, radiate across the head from one point to another. Also, it may appear as a sharp pain, a throbbing sensation, or a dull ache. Headaches can develop gradually or suddenly and may last from less than an hour to several days. Headaches differ greatly regarding pain type, severity, location, and frequency and is a very common condition most people experience during their lifetime.

Causes; Headache pain results from signals interacting among the brain, blood vessels and surrounding nerves. These nerves send pain signals to our brain, causing a headache. There are some environmental factors that can trigger headaches which include eating certain foods or ingredients like caffeine, alcohol, fermented foods, chocolate, and cheese. Also, exposure to allergens, secondhand smoke and strong odors from household chemicals or perfumes can cause headaches. (Holman et al,2019). However, the cause can be grouped into primary and secondary headaches.

A primary headache has no identifiable organic cause but can be due to overactivity of or problems with pain-sensitive structures in the head.  (Mayo Clinic Staff, n.d.). Chemical activity in our brain, the nerves or blood vessels surrounding the skull, or the muscles of your head and neck can play a role in primary headaches. The most common primary headaches are Cluster headache; a very painful type of headache that usually occurs in periods of frequent attacks known as clusters. It causes intense pain in or around one eye on one side of the head. The underlying cause is not really known but alcohol and tobacco use may trigger or worsen cluster headache symptoms. (Cleveland Clinic, n.d.).

Migraine headaches are the most common type of headache characterized by recurrent, throbbing pain that affects one side of the head. The onset of a migraine headache attack may be preceded by a period of symptoms termed an aura which includes vision difficulties, fatigue, and weakness or numbness of the limbs The cause is not known but some environmental factors and stressors including emotional stress, difficulties sleeping, diet and exercise habits, medications, alcohol intake, and hormone levels may contribute to migraine development.

Tension headaches, also known as tension-type headaches (TTH), are characterized by band-like pressure or tightness that affects the forehead, temples, or back of the head. Tension headaches may occur periodically (episodic) or persist constantly for a period of weeks or months (chronic) and can be triggered by stress or patients with Increased sensitivity to pain may experience tension headache.

Secondary headaches are those that are caused by an underlying health condition, including trauma, infections, intracranial disorders, vascular disorders, or psychiatric disorders. Carbon monoxide poisoning, Cerebrovascular accident, Intracranial hemorrhage, Hypertension, Meningitis, encephalitis, acute angle-closure glaucoma, and Brain tumor can also cause secondary headaches and are considered associated risks factor.

Signs and symptoms; Tension headaches symptoms include a feeling of tightness or pressure across the forehead that may extend to the sides and back of the head, and dull pain or tenderness of the head, neck, or shoulders. The sensation of tightness or aching most often affects both sides of the head (bilateral) and is concentrated around the forehead region. Cluster headaches symptoms include intense, severe pain around, above, or behind one eye, with excessive redness, swelling of the eyelid, and tearing of the affected eye. In addition to eye-related symptoms, patients may experience a runny nose on the affected side, facial sweating or redness, and restlessness. Symptoms of migraine headaches include throbbing or pulsing head pain, nausea or vomiting, and sensitivity to light, sound, and other stimuli. The pain is moderate to severe and most often affects one side of the head (unilateral) but can affect both sides of the head (bilateral) in some cases. As a migraine attack progresses, the pain usually becomes more diffuse, spreading posteroinferiorly (backward and downward) before dissipating.

Diagnosis of headache

 Magnetic Resonance Imaging (MRI) is the preferred diagnostic tool for individuals over 50 years but If MRI is unavailable, a CT scan may be used as an alternative. For clients showing additional signs suggestive of conditions like meningitis, encephalitis, or subarachnoid hemorrhage, a lumbar puncture to analyze cerebrospinal fluid (CSF) may be recommended. (Holman et al,2019)

Medications are used to treat headaches.

Acetaminophen (Tylenol)

 Mechanism of action: Acetaminophen is believed to work by inhibiting the production of prostaglandins in the brain that cause pain and fever.

 Before administration: The nurse should check the patient’s medical history for any liver disease or alcohol consumption, as acetaminophen can cause liver damage in high doses or in patients with liver issues.

During administration: Monitor the patient for signs of liver toxicity, such as jaundice, dark urine, or abdominal pain. After administration: Check liver function tests to see if the patient is on long-term or high-dose acetaminophen therapy.

Ibuprofen (Advil, Motrin)

Mechanism of action: Ibuprofen belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs) that work by inhibiting the production of prostaglandins, reducing pain, inflammation, and fever.

Before administration: Assess the patient’s medical history for any history of gastrointestinal ulcers, kidney disease, or cardiovascular conditions, as NSAIDs can exacerbate these conditions.

During administration: Monitor the patient for signs of gastrointestinal bleeding (e.g., black, tarry stools) or renal impairment (e.g., decreased urine output).

After administration: Ensure the patient stays well-hydrated to help protect the kidneys from potential damage.

Sumatriptan (Imitrex)

Mechanism of action: Sumatriptan is a selective serotonin receptor agonist that works by constricting blood vessels in the brain and blocking pain pathways, specifically targeting the cause of migraine headaches.

 Before administration: Assess the patient’s medical history for any history of heart disease or risk factors for cardiovascular events, as triptans can cause vasoconstriction.

During administration: Monitor the patient for signs of chest pain, tightness, or pressure, as well as changes in blood pressure and heart rate.

After administration: Advise the patient to seek medical attention if they experience chest pain or symptoms of a heart attack.

Section 2, Difference between sedative hypnotics and narcotics

Sedative-hypnotics are a class of drugs that have calming (sedative) and sleep-inducing (hypnotic) effects. They are commonly used to treat anxiety, insomnia, and certain sleep disorders. Sedative-hypnotics include drugs like benzodiazepines (e.g., diazepam), non-benzodiazepines (e.g., zolpidem), and barbiturates.

Narcotics, also known as opioids, are a class of drugs that are primarily used for pain relief. They work by binding to opioid receptors in the brain and body, reducing the perception of pain. Common narcotics include drugs like morphine, oxycodone, hydrocodone, and fentanyl.

Commonly used sedative-hypnotics with generic and brand names

Generic; Zolpidem; Brand name – Ambien

Generic; Lorazepam; Brand name-Ativan

Generic; Diazepam; Brand name – Valium

Generic; Alprazolam; Brand name-Xanax

Generic; Temazepam; Brand name – Restoril

Nursing priority before, during, and after sedative-hypnotic administration

Before administration, it is crucial to verify the patient’s identity, check for any allergies, assess baseline vital signs, and review the patient’s medical history to identify any contraindications or potential drug interactions also, it is important to assess the patient’s level of consciousness and confirm the correct medication dosage and route of administration and educate the patient on the potential side effect and safety precautions .During administration,  it is important to closely monitor the patient for any adverse reactions or changes in vital signs. After administration, continue monitoring the patient’s response to the medication and provide appropriate post-administration care. (Simone & Bobrin ,2023)

Reversal agent for sedative-hypnotics

The reversal agent for benzodiazepines, a common type of sedative-hypnotics, is Flumazenil (brand name: Romazicon). Flumazenil acts as a competitive antagonist by binding to benzodiazepine receptors in the brain to counteract the effects of benzodiazepines. It is used (the why) to reverse sedation caused by benzodiazepines in cases of overdose, excessive sedation, or to quickly reverse sedation post-surgery. Flumazenil should be administered cautiously under medical supervision to avoid precipitating withdrawal symptoms in benzodiazepine-dependent patients. It is typically given when respiratory depression or excessive sedation due to benzodiazepine use is a concern.

Here are five commonly used narcotics (opioids) along with their generic and brand names:

Generic; Morphine: Brand names include MS Contin, Roxanol, Kadian.

Generic; Oxycodone: Brand names include OxyContin, Percocet, Roxicodone.

Generic; Methadone: Brand names include Methadose and Dolophine

Generic; Tramadol; Brand name Ultram

Generic; Codeine: Brand names include Tylenol with Codeine, Empirin with Codeine, Robitussin

The number one nursing priority before, during, and after narcotic administration.

Before administration, assess the patient’s pain level, perform thorough physical (CNS, vital signs, urine output) to establish baseline status, assess for allergy and respiratory dysfunction before beginning therapy. During narcotic administration, closely monitor the patient for any side effects related to the narcotic medication. This includes monitoring vital signs such as blood pressure, heart rate, respiratory rate, and oxygen saturation. After administration, determine drug effectiveness and evaluate for any potential adverse effect and monitor its effectiveness in relieving pain.  Additionally, observe the patient for signs of respiratory depression, sedation, dizziness, nausea, vomiting, or allergic reactions. (Cohen et al,2023)

The reversal agent for narcotics is naloxone. Naloxone is the generic name, and one of the common brand names for naloxone is Narcan. Naloxone is an opioid antagonist that works by binding opioid receptors in the body and blocking the effects of opioids, including respiratory depression and sedation.

Naloxone should be given in cases of opioid overdose or when a patient exhibits signs of opioid-induced respiratory depression, such as slow or shallow breathing, or unresponsiveness. It is a life-saving medication used (the why). to quickly reverse the effects of opioids and restore normal breathing.

References

Brandon Cohen; Leigh J. Ruth; Charles V. Preuss. (April 29,2023) Opioid analgesics Statpearl Publishing Retrieved April 6, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK459161/.

Christopher G. Simone; Bradford D. Bobrin. (January 13, 2023.) Anxiolytics and Sedative-Hypnotics Toxicity Statpearl Publishing Retrieved April 6, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK562309/.

Cleveland Clinic. (n.d.). Tension Headaches. Retrieved April 5, 2024, from https://my.clevelandclinic.org/health/diseases/8257-tension-headachesLinks to an external site.

Holman, H. C., Williams, D., Johnson, J., Sommer, S., Ball, B. S., Morris, C., Leehy, P., Hertel, R. (2019) RN Adult Medical Surgical Nursing Review Module, 11th Edition, Assessment Technologies Institute

 Mayo Clinic Staff. (n.d.). Headache Causes. Mayo Clinic. Retrieved April 5, 2024, from https://www.mayoclinic.org/symptoms/headache/basics/causes/sym-20050800Links to an external site.

Yudhveer Brar; Seyed Alireza Hosseini; Abdolreza Saadabadi. (Nov 12,2023) Sumatriptan Statpearl publishing Retrieved April 6, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK430685/?term=sumatriptan.