Pharmacotherapy for Neurological Disorders
Headaches are one of the most commonly reported chief complaints in primary clinics. Headaches can range from mild to debilitating and can last from hours or even days (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). The purpose of this discussion is to explain some of the different types of headaches and how they may be treated pharmacologically. I will also explain how smoking can exacerbate or initiate the development of recurring headaches and provide measures to reduce the negative side effects caused by medications used to treat headaches.
There are three different categories of headaches, but the most commonly seen in primary care are primary and secondary. A headache is termed primary when the clinician can find no identifiable cause of a headache while a secondary headache has been linked to a specific etiology. The most common types of primary headache include a tension-type headaches and migraines. Tension headaches usually cause a dull type of pain that radiates from the forehead to the back of the head that may last from 30 minutes up to several days. Migraines often cause throbbing head pain that is accompanied by nausea, vomiting, photophobia, and phonophobia (Arcangelo et al., 2017). Secondary headaches can be from previous trauma, substance withdrawal, infection, or vascular disorders (Arcangelo et al., 2017). Headaches are the most commonly reported symptom following a head injury according to (Nordhaug et al., 2018). Cluster headaches may be acute and chronic and are considered to be far less common than a migraine or tension headaches. Cluster headaches occur in less than even 1% of the population (Arcangelo et al., 2017). Pain resulting from a cluster headache is often described as burning or causes a feeling of sharp pain through one eye. The pain that is caused by a cluster headache has been reported to be more painful than childbirth and passing kidney stones by some individuals (Arcangelo et al., 2017).
Multiple factors can initiate or make a headache worse and there are likely many headache-producing factors that have not yet been discovered. Cigarette smoking is one behavioral factor that has been identified as being a culprit for causing headaches. Tobacco usage has consistently been identified as being associated with increased number of headaches, especially cluster headaches (Ferrari et al., 2013). Headaches are thought to occur in smokers because of the vasoconstriction of blood vessels caused by nicotine. In the study conducted by Ferrari et al. (2013), individuals who were smokers reported having headaches that lasted longer and that were more severe than those reported by nonsmokers in the same study.
Medications and Side Effects
Prevention is key in the treatment of headaches. Measures that have been shown to reduce the number of headaches and headache severity include getting proper rest, staying hydrated, and the avoidance of smoking and alcohol (Arcangelo et al., 2017). If headaches cannot be managed with nonpharmacological methods alone, there are a variety of medications available that can assist in both prevention of headaches and for relieving pain associated with a headache. Acetaminophen 1,000mg can be used to relieve pain associated with headaches but because of the hepatotoxic qualities of the drug the FDA advises 650mg (Arcangelo et al., 2017). Chronic use of acetaminophen can cause liver damage especially in older individuals. Because of the possibility of liver failure, it is prudent to avoid salicylates or NSAIDs for long-term use. Aspirin is another type of medication that can be used to aid in the alleviation of mild to moderate headache pain. It is important to understand that caution should always be used with prescribing aspirin because of its ability to thin the blood. Aspirin is considered a contraindication in individuals with bleeding disorders, asthma, and hypersensitivity to NSAIDs (Arcangelo et al., 2017).
For long-term prevention of headaches, other medications can be used such as certain antidepressants such as imipramine, doxepin, and protriptyline (Arcangelo et al., 2017). Imipramine should be used with caution in the elderly because it can cause increased confusion, disorientation, delusions, anxiety, and insomnia. Patients receiving Imipramine should also be instructed to eat before taking this medication because it can cause epigastric upset (Drugs.com, 2012). Drowsiness is the most commonly reported side effect of taking doxepin; therefore, patients should be instructed to avoid driving until they know how they will respond to treatment (Drugs.com, 2012). Patients who have been placed on antidepressants should be educated on never stopping their treatment abruptly to avoid the possibility of adverse psychiatric reactions (Drugs.com). Butalbital-containing compounds like Fioricet or Fiorinal may be necessary in certain patients when other medications and treatments have proved unsuccessful. If Fioricet or Fiorinal are necessary, it is pertinent to inform the patient that these should never be used more than three times in one month to prevent medication overuse headaches (MOH) (Arcangelo et al., 2017).
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA:
Lippincott Williams & Wilkins.
Drugs.com. (2012). Retrieved from https://www.drugs. Com/
Ferrari, A., Zappaterra, M., Righi, F., Ciccarese, M., Tiraferri, I., Pini, L. A., … Cainazzo, M. M. (2013). Impact of continuing or quitting smoking on episodic cluster headache: A pilot survey. The Journal of Headache and Pain, 14. https://doi-org.ezp.waldenulibrary.org/10.1186/1129-2377-14-48
Nordhaug, L. H., Hagen, K., Vik, A., Stovner, L. J., Follestad, T., Pedersen, T., … Linde, M. (2018). Headache following head injury: a population-based longitudinal cohort study (HUNT). The Journal Of Headache And Pain, 19(1), 8. https://doi-org.ezp.waldenulibrary.org/10.1186/s10194-018-0838-