Replies for peers. Need ONE Response Per Each Discussion Total 6 Responses. Attached Are The Discussions And Rubric Please Follow Them. Posts Will Be A Minimum Of 100 Words, APA Format.One Reference Per Each Discussion
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JEAN OMEGA FLEURGIN
11 hours ago, at 10:06 PM
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Cluster headache is a primary headache disorder affecting up to 0.1% of the population. Patients suffer from cluster headache attacks lasting from 15 to 180 min up to 8 times a day. The attacks are characterized by the severe unilateral pain mainly in the first division of the trigeminal nerve, with associated prominent unilateral cranial autonomic symptoms and a sense of agitation and restlessness during the attacks. The male-to-female ratio is approximately 2.5:1. Experimental, clinical, and neuroimaging studies have advanced our understanding of the pathogenesis of cluster headache. The pathophysiology involves activation of the trigeminovascular complex and the trigeminal-autonomic reflex and accounts for the unilateral severe headache, the prominent ipsilateral cranial autonomic symptoms.
Epidemiology of Cluster headache
When it comes to differentiate Cluster headache and migraine, it is difficult to assess accurately the prevalence of cluster headache in the community. Nonetheless, given the specific features of cluster headache, it is possible to identify possible cases in the community, using questionnaires based on the ICHD criteria. Community-based studies have been performed to ascertain the prevalence of cluster headache. They are generally modeled on a two-step process. The first step is to screen for possible cluster headache cases either through mailed questionnaires or structured interviews based on the ICHD criteria. Following this, interviews are performed by neurologists or trained interviewers to assess cases further. Fischera et al. reviewed 16 population-based studies published up to August 2007, specifically looking at cluster headache prevalence in a meta-analysis and found that the 1-year prevalence varied greatly between the studies and ranged from 3 to 150/100,000.
What would be your goals for therapy for Richard?
The goal therapy is to decrease the severity of pain, shorten the headache period and prevent the attacks. Briefly inhaling pure oxygen through a mask provides dramatic relief for most who use it. The main goal of his cluster headache is preventive therapy to make Richard cluster-free on preventives even though they are still in a cluster cycle. Preventive agents are absolutely necessary in cluster headache. The maintenance preventive should be started at the time a transitional agent is given. Sometimes very large dosages, much higher than that suggested in the literature, are necessary when treating cluster headache. It is not uncommon for cluster patients to require several preventive medications at once to get better results. Most physicians treating cluster will increase the dosages of the preventive agents very quickly to get a desired response. It is effective the use of sumatriptan, ergotamine, corticosteroids, and other preventive agents. Newer anti-seizure medication like topiramate that appears to be effective in both migraine and cluster headache. Effective for both episodic and chronic cluster sufferers.
References:
Sjaastad O, Bakketeig LS. Cluster headache prevalence. Vågå study of headache epidemiology. Cephalalgia. 2016.
Mengistu G, Alemayehu S. Prevalence and burden of primary headache disorders among a local community in Addis Ababa, Ethiopia. J Headache Pain. 2017.
Joscelyne Lastra
Cluster Headache Description
Cluster headache refers to primary headache syndrome that belongs to the trigeminal autonomic cephalalgias. It is characterized by a recurring adverse unilateral headache that does not or can last more than two to three hours or more. Most cluster headaches are situated behind or on the temple and around one's eye. Cluster headache is considered to affect up to 0.01 of people's population. A severe headache can attack people eight times a day (Brandt et al., 2018). Due to the decreased prevalence of the condition compared to migraine, it is hard to accurately evaluate the cluster headache's prevalence within the community. The community's possible causes of cluster headaches can be identified through questionnaires established on the ICHD criterion. Cluster headaches can be categorized as chronic cluster headaches; they may interfere with work and lifestyles. For instance, in Richard's case, the cluster headaches seem to affect his work performance as he only goes to the office once per week.
Goals for Providing Richard with Therapy
The goal for supporting Richard's therapy would be decreasing the severity of the pain, preventing the attacks, and shortening the headache period. Cluster headache pains occur suddenly and subside over a short period, making it difficult to assess and treat because it needs fast-acting medication. Richard has been experiencing cluster headaches 2-3 times a day, with each pain lasting 40-90 minutes per period. The pain is becoming intense, making it crucial for Richard to seek therapy. The common abortive therapy for the condition includes a high flow of oxygen and subcutaneous sumatriptan. According to Brandt et al. (2018), triptans subcutaneous sumatriptan of 6mg, a selective five-hydroxy tryptamine, and a receptor agonist, works as the best abortive therapy and treatment of cluster headache. Patients suffering from cluster headaches may also use numerous sumatriptan injections daily. These injections act fast to prevent the occurrence of cluster headaches (Wei & Goadsby, 2021).
References
Brandt, R., Doesborg, P. & Fronczek, R. (2018). Pharmacotherapy for cluster headache.
Wei, D. Y., & Goadsby, P. J. (2021). Cluster headache pathophysiology—insights from current and emerging treatments. Nature Reviews Neurology, 17(5), 308-324.
Villelixe Soto
Cluster headaches are often painful and involve only one side of the head. The cluster headache feels like intense pain, especially eye pain involving only one eye and radiating to areas of your neck, face, head, and shoulders (Uluduz, Ayta, Özge, Yalin & Taşdelen, 2018). The exact cause of cluster headaches is unknown. Excessive use of medication to treat headaches can actually cause headaches. This is the most common secondary headache disorder, and it affects up to 5 percent of the population. Medication overuse headaches tend to be worst upon awakening. Many people who get cluster headache attacks are smokers.
The goal of therapy is to decrease the severity of pain, shorten the headache period and prevent the attacks. Because the pain of a cluster headache comes on suddenly and might subside within a short time, cluster headache can be difficult to evaluate and treat, as it requires fast-acting medications.
Some scientific evidence has shown that cigarette smoke can make various types of headaches worse (Leone, Giustiniani & Cecchini, 2017). Smoking can raise carbon monoxide levels in the brain and blood, which may cause headaches to form or worsen. When the body receives less oxygen during smoking sessions, tissues don’t get the oxygen they need to function properly. And since nicotine has a toxic effect on the brain, it may interfere with medications that one takes to manage headaches.
References
Leone, M., Giustiniani, A., & Cecchini, A. (2017). Cluster headache: present and future therapy. Neurological Sciences, 38, 45–50. https://doi.org/10.1007/s10072-017-2924-7
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Amniellys Rodriguez
Describe Cluster Headache and its epidemiology.
Cluster headaches tend to occur in a cyclical pattern or cluster periods, and they are some of the most painful types of headaches. People usually wake up in the middle of the night with intense pain that can be around one eye or on one side of their head. People can suffer from these headaches lasting from weeks to months. They are not very common and do not present any danger to a person’s life. They tend to attack the person quickly and without any warning. Some of the most common symptoms of cluster headaches include pain on one side of the head or face, tears coming out of the eyes in an excessive manner, blocked sinuses, sweating and/or flushing on the side of the pain, and drooping eyelid on the affected side, among other signs and symptoms.
With regards to the epidemiology, it can be said that about 3 to 150 people out of 100,000 tend to be affected by cluster headaches. Most of the patients are males and some genetic aspects have also been identified. With regards to the race, it is depicted that the majority of the patients are Caucasians, whereas it is the rarest in people from African descent (Wei et al., 2018).
What would be your goals for therapy for Richard? Give rationale with evidence from articles.
The goal of the treatment would be to decrease the severity of the pain, as well as to shorten the headache period and to prevent the attacks. This is because there is no cure for cluster headaches (Dodick et al., 2018). Some medications can provide quick relief, such as oxygen and triptans. Calcium channel blockers have also been used successfully in helping to prevent cluster headaches.
References
Dodick, D. W., Rozen, T. D., Goadsby, P. J., & Silberstein, S. D. (2018). Cluster
headache. Cephalalgia, 20(9), 787-803.
Wei, D. Y. T., Ong, J. J. Y., & Goadsby, P. J. (2018). Cluster headache: epidemiology,
pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(Suppl 1), S3.
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Henly Rojas
Cluster Headaches and Their Epidemiology
Cluster headache (CH) is an example of a rare and severe headache. It can be said that CH is signified by strong unilateral pain, mainly located infraorbital. Patients may present with one or more of the following signs and symptoms: tearing, nasal congestion, facial edema, and ptosis. Another point to note is that CH episodes last from 15 minutes to 3 hours and can occur at any time such as watching television, drinking alcohol, stress, increased physical activity, and hot weather. Most patients who present this condition develop it between 30 and 50 years of age. It is considered that the affected people exceed 0.1% worldwide, and many times they are misdiagnosed, such as migraine. Likewise, it is a point to highlight that the male sex has a higher incidence than the female sex and that the chances of suffering from it are greater when there are relatives who have this condition. One of the highest incidences of this condition is seen in smokers. It is worth noting that not much is known about the etiology and epidemiology of this disease due to its rarity compared to other types of headaches.
Goals for Therapy for Richard
The main purpose of Richard's treatment is to relieve his headaches, as there is no cure for CH. To achieve this goal, our patients must be treated with 100% oxygen or triptans. When choosing a therapy for this condition, the wishes of our patients must be considered, since medical insurance does not cover oxygen therapy. It should be mentioned that triptans are valued as the most effective drugs for CH and can be included in Richard as an alternative therapy to oxygen therapy. For faster action, triptans should be administered subcutaneously as sumatriptan or as a nasal spray such as zolmitriptan. A large majority of patients like nasal sprays as they are more affordable to administer. The disadvantage of triptans with respect to oxygen therapy is that they have side effects such as dizziness and fatigue. The first thing that must always be considered is the safety of our patients, which is why Richard should be advised to start treatment with oxygen therapy and switch to a triptan if there is no response.
References
Mavridis, T., Breza, M., Deligianni, C., & Mitsikostas, D. D. (2021). Current advances in the management of cluster headaches. Expert Opinion on Pharmacotherapy, 22(14), 1931-1943. https://doi.org/10.1080/14656566.2021.1924148
Goadsby, P., Wei, D. T., & Yuan Ong, J. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(5), 3. https://doi.org/10.4103/aian.aian_349_17
Moser, T., & Robinson, M.V. (2016). Pharmacotherapeutics for Advance Practice Nurse Prescribers. (4th ed.). Philadelphia: F. A. Davis Company.
Luanda Gan Bedoya
Cluster Headaches and Their Epidemiology
Cluster headaches cause severe pains. They can be excruciating and deliberating pain, lasting from 15 minutes to three hours (Wei et al., 2018). This type of pain occurs mostly around or through one eye or in the temple; it can last for weeks to several months. Patients may suffer from cluster headaches at least once or twice a year. This pain occurs repetitively daily around the same time. Statistically, cluster headaches occur in females less than males. According to Wei et al. (2018), one in 250 men suffer from cluster headaches. In males, the onset of this condition is common at the age of between 20 and 45, while in females, it occurs later in life (Mavridis et al., 2021). This disease has no genetic history, but occasionally, cluster headaches are registered in family members. Overall, a cluster headache is severe, and it starts quite quickly without a warning.
Goals for Therapy for Richard
Since Richard experiences headaches of increasing intensity, it is best to administer him prednisone. He could take 20mg tablet of prednisone in the morning and evening for four days and then reduce the dose to 20mg/day for another four days; he should take 10mg/day for another six days (Mavridis et al., 2021). Prednisone will help reduce the acute attack of cluster headache. With the decrease of prednisone dose, the patient should start taking a form of verapamil. Thus, he will begin at a dose of 240mg/day and then increase to two doses per day (Wei et al., 2018). Alternatively, Richard should consider using oxygen as an abortive strategy for his cluster headaches. Additionally, he should be advised to apply ice to the areas of pain. The patient will also be given 10 mg/day tablets or 4mg injections of sumatriptan. The latter is a better alternative because it is more effective for pain (Woo & Robinson, 2016). In case pain persists, the patient will be provided with additional lithium or valproate. These pharmaceutical therapies are expected to help resolve Richard's cluster headaches.
References
Mavridis, T., Breza, M., Deligianni, C., & Mitsikostas, D. D. (2021). Current advances in the management of cluster headaches. Expert Opinion on Pharmacotherapy, 22(14), 1931-1943. https://doi.org/10.1080/14656566.2021.1924148
Wei, D. Y. T., Ong, J. J. Y., & Goadsby, P. J. (2018). Cluster headache: epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(Suppl. 1), S3-S8. https://dx.doi.org/10.4103%2Faian.AIAN_349_17
Woo, T., & Robinson, M. (2016). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). F. A. Davis Company.
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