Headaches are a common nuisance that many people experience at one time or another due to stress, poor sleep, and illness. There are over 150 different types of headaches with the most common being: tension headaches, cluster headaches, or a more debilitating migraine headache.
Headaches can be classified as either primary or secondary. Migraine, tension, and cluster headaches are classified as primary headaches while headaches that are caused by other health conditions like a neck injury, brain tumor, or sinus infection are considered secondary headaches.
The most common type of headache is a stress headache or tension-type headache (TTH). This condition is described as mild to moderate pressing pain on the forehead occurring bilaterally that can last from several minutes to several days.
A cluster headache is considered the most painful form of primary headache. Pain is unilateral and accompanied by nasal drainage or stuffiness and eye tearing. This condition is characterized by repeated headaches occurring in ‘cluster’ patterns for days or weeks followed by periods of remission.
Migraine headaches are a recurring type of headache described as unilateral throbbing pain. These commonly occur between the ages of 25 and 50 and are more common in females. Migraines may occur with an aura or more commonly, without warning. Chronic migraines are diagnosed when they are experienced at least 15 days per month.
The exact cause of migraines is currently unknown but many experts believe that it starts with a complex series of neurovascular events like neuron hyperexcitability in the cerebral cortex. In some cases, a migraine headache is precipitated by triggers like bright lights, certain odors, high stress, poor sleep, hormone fluctuations, and food like chocolates, cheese, and alcoholic beverages.
Clinical manifestations of migraine headaches include:
- A steady unilateral throbbing that is synchronous with the person’s pulse
- Nausea and vomiting
- Sweating or chills
- Dizziness and blurred vision
- Sensitivity to light, sound, and odors
Diagnosing migraine headaches will include a detailed medical history, as neurologic examinations often reveal normal results. There are no specific laboratory or diagnostic tests that can diagnose this condition.
The Nursing Process
Headaches tend to range from mild to severe and can be incapacitating to the patient. It is essential to identify the type of headache the patient is experiencing. Nurses must take a detailed patient history of the patient’s condition and determine if an underlying disease is contributing to the condition.
Treatment usually includes medications like NSAIDs and acetaminophen used alone or in combination with muscle relaxants, sedatives, or caffeine. Preventive interventions may be indicated for migraine headaches and interventions are based on the severity, frequency, and disability of the condition.
Therapy may also be indicated for patients suffering from headaches. Nurses support their patients undergoing cognitive-behavioral therapy and relaxation therapy through patient education and monitoring.
Nursing Care Plans Related to Headache and Migraine
Acute Pain Care Plan
Pain is subjective and may be experienced differently from one patient to another. Pain felt in migraine and other types of headaches can range from mild to severe, and can be recurring and disabling.
Nursing Diagnosis: Acute Pain
- Pressure, throbbing, or aching to the temples, eyes, sinuses, or base of the skull
- Migraine episode
As evidenced by:
- Guarding or protective behavior
- Positioning to ease pain
- Increased heart rate
- Facial grimace
- Reports of pain
- Flat affect
- Loss of appetite
- The patient will report a reduction in pain using the numeric pain scale
- The patient will be able to complete daily tasks without disruption due to pain
Acute Pain Assessment
1. Assess the patient’s pain experience.
Pain is subjective and must be assessed meticulously based on its characteristics, onset, frequency, intensity, and quality. A detailed pain assessment can help determine the type of headache and develop the most appropriate treatment regimen.
2. Assess and monitor vital signs.
Vital signs may be altered during a patient’s pain episode. Fluctuations can indicate whether the patient’s condition is improving or worsening.
Acute Pain Interventions
1. Administer pain medications as indicated.
OTC medications specific to migraines are available. Prescription-strength medication such as Fioricet may be required. Pain medications should be administered before the onset of the pain or during the prodrome phase when symptoms such as irritability or difficulty concentrating begin.
2. Teach patients non-pharmacologic pain management.
Nonpharmacologic pain management techniques like relaxation, cool compresses, darkness, and massage can help with pain relief. Moreover, these do not have any side effects or risk of dependence.
3. Schedule activities during the peak effects of pain relievers.
Headache pain can be debilitating and prevent the patient from working, caring for family, and ADLs. Schedule nursing tasks and patient care when pain is most controlled.
4. Identify precipitating factors.
Migraine headaches can have triggers such as stress, missed meals, too much caffeine or caffeine withdrawal, weather changes, exhaustion, exposure to smoke or strong odors, and more. Helping the patient identify specific instances of migraine occurrences can decrease episodes.
Impaired Comfort Care Plan
Patients suffering from migraines and other types of headaches often experience impaired comfort. Impaired comfort refers to an apparent lack of relief and peace in relation to a person’s physiological, environmental, spiritual, intellectual, and social patterns.
Nursing Diagnosis: Impaired Comfort
- Headache and migraine pain
- Anxiety and worry
- Inadequate sleep
- Lack of support systems
- Associated symptoms such as nausea/vomiting, dizziness, etc.
As evidenced by:
- Expressed pain, anxiety, or worry
- Lack of sleep or restlessness
- Difficulty relaxing
- The patient will verbalize an improved sense of emotional relief and comfort
- The patient will participate in strategies and interventions to improve spiritual and psychological comfort
Impaired Comfort Assessment
1. Assess the effect of impaired comfort on lifestyle.
Assess how the patient’s impaired comfort affects their ability to form relationships, maintain a career, and reach goals. This can direct interventions.
2. Assess current coping strategies.
Determine what the patient currently does to increase comfort. Does the patient have a support system, religious beliefs, or even negative coping behaviors? The patient may need redirection or additional resources.
3. Assess the patient’s goals for comfort.
Before interventions can be implemented and evaluated, the nurse must determine what the patient’s comfort goals are and what is important to their daily level of functioning.
Impaired Comfort Interventions
1. Administer medications as indicated.
Pain medications can initially assist with pain that is causing impaired comfort. Additional medications such as antiemetics to help with nausea or antihistamines for dizziness and sleep aids can all improve comfort.
2. Establish a reliable and trusting relationship with the patient.
A trusting relationship encourages open and honest communication. Building a rapport can increase adherence to the treatment plan.
3. Minimize noise and stimuli.
Dim lighting in a cool and quiet room can induce comfort. Speak calmly and quietly to the patient when required.
4. Consider therapy consults.
Outward stress and personal issues can trigger headaches and prevent feelings of comfort. Encourage or provide opportunities to work with a counselor that may be able to develop coping strategies to control emotional stress.
Deficient Knowledge Care Plan
Patient education is an integral part of any treatment regimen to ensure compliance, prevent complications, and restore patients’ health. Inaccurate information can lead to poor adherence and unnecessary anxiety and expenses.
Nursing Diagnosis: Deficient Knowledge
- Inadequate access to resources
- Inadequate awareness of resources
- Lack of information
- Inadequate participation in care planning
- Lack of interest/motivation
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about a topic
- Poor control of symptoms
- The patient will verbalize understanding their disease process by exhibiting adherence to the treatment regimen
- The patient will seek information on adjunctive treatment and lifestyle changes to improve health
Deficient Knowledge Assessment
1. Assess the patient’s ability to learn.
Assess the patient’s ability to learn and determine possible barriers to learning to formulate an appropriate teaching plan.
2. Assess the patient’s willingness to learn.
Learning readiness is essential to patient education as it will determine how likely a person will seek out knowledge and participate in the learning process.
3. Acknowledge any cultural differences.
Acknowledging any cultural differences will establish rapport with the patient and improve therapeutic communication with the patient.
Deficient Knowledge Interventions
1. Educate on different treatment options.
Migraine treatments continue to improve. Other than analgesics, antidepressants, anti-seizure drugs, blood pressure medications, vitamins, and even Botox injections are used to treat migraines.
2. Provide accurate information and dispel myths.
There is still much to learn about headaches and migraines. Provide accurate information from reputable sources that the patient is able to understand.
3. Encourage a headache diary.
Have the patient keep a diary surrounding headaches and migraine episodes. This information can help with understanding possible triggers and changes to make in diet or lifestyle.
4. Consider resources.
Headaches and migraines can feel isolating. If the patient does not already see a neurologist, this specialist can offer expert treatment. Support groups may also help with feeling understood by others by sharing similar experiences.
References and Sources
- Is It a Migraine or Headache? Temple Health. Posted July 16, 2021 by Carla LoPinto-Khoury, MD. https://www.templehealth.org/about/blog/is-it-migraine-or-headache
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, PhD, FAADN, CNE. 2020. Elsevier, Inc.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Migraine Headaches. Cleveland Clinic. Last reviewed by a Cleveland Clinic medical professional on 03/03/2021. https://my.clevelandclinic.org/health/diseases/5005-migraine-headaches
- Migraine vs. Headache: How to Tell the Difference. PennMedicine. March 31, 2022. https://www.pennmedicine.org/updates/blogs/health-and-wellness/2019/november/migraines-vs-headaches
- Pescador Ruschel MA, De Jesus O. Migraine Headache. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/