There are two types of migraine headaches: classic migraine and common migraine. Classic migraine has a prodromal (preheadache) phase that lasts approximately 15 minutes and is accompanied by disturbances of neurological functioning such as visual disturbances, speech disturbances, and paresthesias. Neurological symptoms cease with the beginning of the headache, which is often accompanied by nausea and vomiting. Common migraine does not have a preheadache phase but is characterized by an immediate onset of a throbbing headache.
Although the causes of migraine headache are uncertain, a commonly held theory is that early vasoconstriction and subsequent vasodilation occur because of the release of biologically active amines such as serotonin, norepinephrine, and epinephrine. These amines are powerful vasoconstrictors, and after their release, degradation and depletion may lead to vasodilation and the headache syndrome. Another theory suggests that neurokinin, a biologic substance similar to bradykinin, may be responsible for the inflammatory response.
Nursing care plan assessment and physical examination
Elicit a history of contributing, or triggering, factors such as consumption of red wine, chocolate cake, cheese, alcohol, caffeine, and foods high in refined sugar. Other triggers are the smell of perfume, presence of flickering lights, intake of nicotine, hunger, fatigue, sleep deprivation, physical exertion, and emotional stress. Ask the patient to describe the symptoms that are associated with the headache. Generally, migraine headaches are unilateral with pulsating or throbbing pain and are associated with nausea, vomiting, and phonophotophobia (intolerance to light and noise). Duration lasts from 4 to 72 hours, although the pain builds over minutes to hours.
Elicit a description from the patient of all symptoms. Classic migraines are associated with a transient visual, motor, sensory, cognitive, or psychic disturbance that lasts up to 15 minutes and precedes the headache. A second phase occurs with numbness or tingling of the lips, changes in mental status (confusion, drowsiness), aphasia, and dizziness. Common migraines have an immediate onset of throbbing pain. Early warning is often a mood change, and pain is often accompanied by nausea and vomiting. Elicit the timing and pattern of episodes. Two to four attacks a month, often beginning in the mornings and usually lasting a day or two, are a common pattern. If the patient is a female, determine the timing of the menstrual cycle, any birth control pills or hormone replacement therapy, and if the patient is pregnant.
Perform a neurological assessment to determine focal neurological dysfunction (such as drowsiness, vertigo, aphasia, unilateral weakness, confusion) and visual disturbances (such as spots, lines, or shimmering light). Test the cranial nerves, particularly cranial nerves V, IX, and X. The patient has no signs and symptoms when the headache is not present, but other disorders need to be ruled out before the initial diagnosis of migraine headache is made.
Psychosocial assessment should include assessment of the degree of stress the person experiences and the strategies she or he uses to cope with stress. Determine the patient’s lifestyle patterns, such as exercise patterns, family relationships, rest and work patterns, and substance abuse patterns.
Nursing care plan primary nursing diagnosis: Pain related to vasoconstriction or vasodilation.
Nursing care plan intervention and treatment plan
Most patients can have their migraine headaches managed pharmacologically. Dietary modification may decrease symptoms; this includes reducing the intake of caffeinated beverages, monosodium glutamate, cheese, sausage, sauerkraut, citrus fruit, chocolate, and red wine. Teach the patient to avoid triggers that may lead to headaches. Patients may be sensitive to odors from cigarette or cigar smoke, paint, gasoline, perfume, or aftershave lotion. Explain to the patient that at the beginning of an attack, he or she may be able to limit pain by resting in a darkened room. If patients sleep uninterrupted with their eyes covered, symptoms may be alleviated. A combination of complementary therapies may be successful in managing symptoms. Introduce to the patient the possibility of behavior therapy such as biofeedback, exercise therapy, and relaxation techniques. Explore with the patient some techniques for stress reduction and adequate rest. Discuss family- or work-related stress to determine a regimen that may reduce stress and provide for adequate rest and relaxation. Lifestyle management may be essential to control headaches. Ask a dietician to evaluate the patient’s food intake and to work with the patient to develop a diet that will minimize exposure to triggers.
Nursing care plan discharge and home health care guidelines
Teach the patient how to maintain lifestyle changes with regard to rest, nutrition, and medication management. Make sure that the patient and family of the treatment regimen. Review dietary limitations and recommendations, and make sure the patient understands the dosage and side effects of all medications. Provide a referral to a headache clinic that teaches alternative therapies.