a. Lorazepam (Ativan)
b. Acetaminophen (Tylenol)
c. Morphine sulfate (Roxanol)
d. Butalbital and aspirin (Fiorinal)
The patient’s symptoms are consistent with a tension headache, and initial therapy usually involves a nonopioid analgesic such as acetaminophen, sometimes combined with a sedative or muscle relaxant. Lorazepam may be used in conjunction with acetaminophen but would not be appropriate as the initial monotherapy. Morphine sulfate and Fiorinal would be more appropriate for a headache that did not respond to a nonopioid analgesic.
a. refer the patient for counseling to assist with stress reduction.
b. ask the patient to keep a diary with details about headaches.
c. encourage the patient to learn muscle-relaxation techniques to minimize headache frequency.
d. teach the patient about the effectiveness of the triptan drugs in treating migraine headaches.
The initial nursing action should be further assessment of the precipitating causes of the headaches, quality and location of pain, etc. Stress reduction, muscle relaxation, and the triptan drugs may be helpful, but more assessment is needed.
a. “I will take the topiramate (Topamax) as soon as any headaches start.”
b. “The sumatriptan (Imitrex) will help to increase the blood flow to my brain.”
c. “I will try to lie down someplace dark and quiet when the headaches begin.”
d. “A glass of wine might help me relax and prevent headaches from developing.”
It is recommended that the patient with a migraine rest in a dark, quiet area. Topamax is used to prevent migraines and must be taken for several months to determine effectiveness. Blood flow to the brain is decreased by the triptan drugs. Alcohol may precipitate migraine headaches.