ALS and HEADACHES

Migraine:

Defined as a severe unilateral headache that is thought to be the result of a vascular disturbance. Serotonin is thought to be involved, which first constricts, then dilates blood vessels.

6 Tension or Muscle Contraction Headaches:

These HA's are related to muscle contractions which leads to the following s/s: • tension • feelings of nervousness • bilateral pain, mostly in back of neck, or • band-like, top of head. Some patients report that these HA's last for years. Treatment: • ASA (GI bleed) • Tylenol (liver problems) • relaxation techniques • heat, massage • muscle relaxants and antidepressants

cluster migraine

This is defined as a severe crushing headache, which occurs in clusters; also thought to be a result of a vascular disturbance. Further, there is an ⇑ in plasma histamine level which leads to abrupt onset which peaks quickly—in about 5 minutes. May be triggered by alcohol ingestion. s/s: More frequent in men, 30-60 years of age. HA's lasts from 15 min to 2 hours. • conjuctivitis • teary-eyed • nasal congestion on affected side Treatment: • ergotamine drugs • caffeine • Sansert • Thorazine • Inderal

Manifestations,

depend on the affected motor neurons because specific motor neurons affect specific muscle fibers. Chief symptoms are: progressive muscle weakness, atrophy and fasciculation's. Because the anterior horn cells are affected, where does the weakness and atrophy mostly occur? Muscles of: 1. arms 2. trunk 3. legs The bowel and bladder sphincters are not affected, and the patient remains continent.

Although emotional lability may be present, intellectual function is not impaired. Discuss:

prognosis: poor cause of death: respiratory failure & or aspiration average survival following onset: diagnosis: based on s/s • What does EMG show? Abnormal muscle conduction

In about 25% of patients diagnosed with ALS, related to loss of motor neurons in brain stem (think cranial nerves), there will be difficulty:

talking • swallowing, and ultimately, the gravest • breathing.

Nsg Management:

treatment of s/s; rehab measures for immobility • support family and improve quality of life • medications anti-spasmodics - Baclofen muscle cramps - quinine medication that slows progression of disease - ? riluzole (Rilutek) • why is gastrostomy tube placed? • Why are advance directives so important?

Nursing Interventions for Headaches:

• Treat acute episode • Prevent recurrence • Pt. education regarding causal factors • Comfort measures include: • Quiet, dark room • HOB ↑ to increased intracranial pressure • Appropriate medications • Instruct patient to keep diary to track what led to HA • Regular periods of rest and relaxation • Recommend contacting: The National Headache Foundation American Foundation for the Study of Headaches

Amyotrophic Lateral Sclerosis (ALS) AKA Lou Gehrig's Disease:

ALS is a disease of unknown etiology in which there is a loss (degeneration) of motor neurons in the anterior (or ventral) horns of the spinal cord, as well as the motor nuclei of the lower brain stem. As these cells die, the muscle fibers, which they would have supplied with stimulus, undergo atrophy. This degeneration of neurons may occur in both the upper and lower motor neurons. This disease affects more men than women, usually in the age range of 40 to 50 years of age. This is a fatal disease, thought to be autoimmune in origin. Death usually occurs within 2-6 years after diagnosis, due to respiratory failure.

Organic:

Headaches that occur as a result of another disease (e.g. sinus, brain hemorrhages, meningitis, brain tumors, etc.) When related to brain tumor: • worse when first arising • ↓ as venous drainage drops the ICP • usually mild at first; become severe

s/s: of migraine

One-sided, with at least one of the following characteristics: N/V, sensitivity to light, noise, or smell. Familial tendency, and usually females affected—represent 60% of migraine sufferers. Thought to be related to: • hormonal changes • stress • various foods will lead to attacks, or skipped meals • changes in weather • bright or flickering lights • strong odors (e.g. perfumes) • over-sleeping, or lack of exercise

Treatments:

Preventive: beta blockers—Inderal, which blocks the sympathetic NS, leading to decreased blood vessel dilation in brain; calcium channel blockers,tricyclic antidepressants, oral contraceptives if headaches hormonal. Sansert—decreases serotonin levels in brain. Must discontinue after 6 months or could lead to cardiac/pulmonary/retroperitoneal fibrosis. • Abortive: 1st line: NSAIDS with Reglan to speed absoption and ↓ nausea, triptans - constricts vessels, but may have cardiovascular affects (Imitrex, Maxalt, Zomig, Axert) Midrin (constricts vessels and contains a sedative) 2ndline: Ergotamine—take early; blocks serotonin in brain. Also Cafergot, caffeine.

Pathophysiology:

• Cerebral blood vessels constrict, then dilate ⇒ HA, • inflammatory ∆'s occur in vessels • aura: flashing lights, numbness and tingling in face and hands, weakness and confusion

classical vs common migraine

• Classical: occurs in 10% of cases • aural state last 10-30 minutes • HA peaks in one hour and has duration of several hours • Common: • no aural phase • lasts hours to days