Patient Care and Monitoring

© Regimens for headache disorders should be individualized based on headache type, pattern of occurrence, response to therapy, medication tolerability, and comor-bid medical conditions.

1. Assess the patient complaint to yield a detailed description of headache: precipitating factors; presence or absence of prodromal symptoms; location, intensity, and duration of pain; changes in sensory acuity, and; neurologic alterations.

2. Determine if immediate referral for emergency or specialist care is necessary.

3. Identify medication allergies, and obtain a thorough history of nonprescription and prescription drug use and complementary and alternative therapies utilized.

4. Identify the presence of drug-drug interactions that may guide therapeutic decision making in regard to selecting acute and prophylactic headache treatments.

5. Obtain a complete medical and social history, and identify any potential drug-disease interactions or social factors that may influence treatment choices.

6. Obtain a family medical history, focusing on headache or mental health disorders in first degree relatives.

7. Complete a review of systems and physical examination to identify causes or complications of headache.

8. Determine the type of headache disorder and rule out acute complications.

9. Recommend appropriate pharmacologic therapy to abort headache based on type, patient characteristics, current medication profile, and comorbid conditions.

10. Educate the patient on administration, maximum dosage, and anticipated adverse effects of the prescribed medication.

11. Recommend appropriate nonpharmacologic therapy to abort headache and to prevent future headaches.

12. Determine if the patient is a candidate for prophylactic pharmacologic therapy.

13. Recommend appropriate pharmacologic treatment for the prevention of future headaches.

14. Assess response to therapy indicated by the absence of pain and a return to normal activities. Assess response to prophylactic therapy by improvements in headache frequency and severity.

15. Instruct the patient to keep a headache diary to identify potential causes of headaches and responses to therapy.

16. Provide the patient specific information regarding actions to take, if therapy is ineffective or adverse effects develop.

17. Educate the patient on the importance of adherence to their individualized pharmacologic regimen to prevent headache and to diminish pain upon recurrence.

18. Educate the patient on the warning symptoms and signs of headache complications, and when to seek emergency medical attention.

Abbreviations Introduced in This Chapter

ACEI

Angiotensin-Converting enzyme inhibitor

AMI

Acute myocardial infarction

ARB

Angiotensin receptor blocker

ccu

Coronary care unit

CGRP

Calcitonin gene-related peptide

CH F

Congestive heart failure

COX-2

Cyclooxygenase type 2 inhibitor

CSF

Cerebrospinal fluid

CT

Computed tomography-

CTA

Clear to auscultation

CYP

Cytochrome P450 isoenzyme system

DHE

D i hyd roe rgot amine

ESR

Erythrocyte sedimentation rate

GABA

y-Aminobutyric acid

GERD

Gastroesophageal reflux disease

ICHD

International Classification of Headache

Disorders

IHS

International Headache Society

MAO-A

Monoamine oxidase type A

MRG

Murmur, rub, gallop

NSAID

Nonsteroidal anti-inflammatory drug

OTC

Over-the-counter

RR

Respiratory rate

SNRI

Scrotonin-norepincphrine reuptake inhibitor

SSRI

Selective serotonin reuptake inhibitors

TC.A

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^ Self-assessment questions and answers are available at ht-tp://www. mhpharmacotherapy. com/pp.html.

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