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Causes and symptoms
- caffeine products, and caffeine withdrawal
- intensely sweet foods
- dairy products
- fermented or pickled foods
- citrus fruits
- processed foods, especially those containing nitrites, sulfites, or monosodium glutamate (msg)
- oral contraceptives
- estrogen replacement therapy
- decongestant overuse
- analgesic overuse
- benzodiazepine withdrawal
- Eating at regular times, and not skipping meals.
- Reducing the use of caffeine and pain-relievers.
- Restricting physical exertion, especially on hot days.
- Keeping regular sleep hours, but not oversleeping.
- Managing one's time efficiently in order to avoid stress at work and home.
- beta blockers
- tricyclic antidepressants
- calcium channel blockers
- selective serotinin reuptake inhibitors (SSRIs)
- monoamine oxidase inhibitors (MAOIs)
- serotonin antagonists
Immediate attention by a health care provider is indicated when (1) a severe headache comes on suddenly without apparent cause; (2) there are accompanying symptoms of neurological abnormality, for example, blurring of vision, mental confusion, loss of mental acuity or consciousness, motor dysfunction, or sensory loss; or (3) the headache is highly localized, as behind the eye or near the ear, or in one location in the head. Fever and stiffness of the neck accompanying the headache may indicate meningitis.
Synonym(s): hemicrania (1) , sick headache.
|Mean LOS:||3.3 days|
|Description:||MEDICAL: Seizures Without Major CC|
Migraine headache is a primary headache syndrome that is an episodic vascular disorder with or without a common aura. Approximately 30 million people have migraine headaches in the United States. A migraine headache is a prototype of a vascular headache, which involves vasodilation and localized inflammation. Ultimately, arteries are sensitized to pain. Cerebral blood flow is diminished before the onset of the headache and is increased during the actual episode. Most migraine sufferers have a trigger, or precipitating factor, that is associated with the onset of symptoms.
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, dopamine, norepinephrine, and epinephrine. Serotonin seems to be the most important of these substances. These amines, which stimulate an inflammatory cascade with the release of endothelial cells, mast cells, and platelets, are powerful vasoconstrictors, and after their release, degradation and depletion may lead to vasodilation and the headache syndrome. Another theory suggests that neurokinin, a biological substance similar to bradykinin, may be responsible for the inflammatory response.
The inheritance of migraine headaches has been written about since the late 1920s. Twin studies have reported a recurrence risk of migraine with aura at 50% in identical twins and 21% in nonidentical twins. Several loci have been linked or associated with typical migraines. Two genes implicated in the rare disease familial hemiplegic migraine (FHM) have been described. FHM is usually transmitted in an autosomal dominant pattern, primarily from the mother.
Gender, ethnic/racial, and life span considerations
Migraine headaches generally begin in childhood or near puberty, affect females more than males, and decrease in frequency and severity as people age. It is uncommon for migraine headaches to occur during old age. Migraine headaches often increase in frequency during pregnancy in the first trimester for those who have experienced them before pregnancy. Oral contraceptives and hormone replacement therapy also increase the frequency of headaches. Migraine headaches have a higher prevalence among people with European ancestry than those with African or Asian ancestry. In the United States, households with lower educational levels and lower economic resources have higher migraine prevalence.
Global health considerations
The World Health organization reports that the prevalence of migraines are highest in North America, followed by other regions of the globe.
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 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 is 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.
The most common symptom is a throbbing, pulsatile headache. Perform a neurological assessment to determine focal neurological dysfunction (e.g., drowsiness, vertigo, aphasia, unilateral weakness, confusion) and visual disturbances (e.g., 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.
No test is diagnostic for migraine headaches. The following tests may be necessary for differential diagnosis: computed tomography scan, skull x-ray, cranial nerve testing, arteriogram, lumbar puncture, cerebrospinal fluid testing, electroencephalogram, and magnetic resonance imaging.
Primary nursing diagnosis
DiagnosisPain related to vasoconstriction or vasodilation
OutcomesComfort level; Pain control behavior; Pain level; Symptom control behavior; Symptom severity; Pain: Disruptive effects; Well-being
InterventionsMedication administration; Medication management; Pain management; Comfort; Nutritional monitoring; Environmental management: Comfort; Biofeedback; Sleep enhancement; Guided imagery
Planning and implementation
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.
|Medication or Drug Class||Dosage||Description||Rationale|
|Nonnarcotic analgesics||Varies with drug||Either aspirin, acetaminophen, or NSAIDs may abort a migraine headache if taken early; ketorolac tromethamine, ketoprofen, naproxen sodium, flurbiprofen, indomethacin, isometheptene, butalbital with aspirin, and acetaminophen reduce headache pain||Abort or relieve a migraine headache|
|Serotonin 5-ht-receptor agonists (sumatriptan, naratriptan, zolmitriptan, rizatriptan, almotriptan, frovatriptan, eletriptan)||Varies with drug||Serotonic receptor stimulant; antimigraine that acts by binding with vascular receptors producing a vasoconstrictive effect on cranial blood vessels||Acts on receptors on intracranial blood vessels and sensory nerve endings to relieve migraine headache|
|Prochlorperazine||5–10 mg IV||Antiemetic, antipsychotic that terminates migraines and helps alleviate nausea||Relieves a migraine headache|
|Ergotamine||2–3 mg PO; may add additional doses to reach 6 mg in a 24-hr period or 10 mg/wk||Antimigraine that may have an agonist/antagonist action with alpha-adrenergic, serotonergic, and dopaminergic receptors; directly stimulates vascular smooth muscle, constricting arteries and veins||To prevent or abort migraine headache|
|Dihydroergotamine (DHE)||1–2 mg IM or SC; during the peak of a headache 5–10 mg or prochlorperazine may be given IV followed by 0.75 mg of DHE IV over 3 min||Venoconstrictor with minimal peripheral arterial constriction; use with caution with patients with cardiac disease||Relieves the pain of migraine headache|
|Beta blockers, tricyclic antidepressants, calcium channel blockers||Varies with drug||Used to prevent headaches, particularly those that do not respond to acute therapy||To prevent migraine headaches|
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.
Evidence-Based Practice and Health Policy
Spector, J.T., Kahn, S.R., Jones, M.R., Jayakumar, M., Dalal, D., & Nazarian, S. (2010). Migraine headache and ischemic stroke risk: An updated meta-analysis. The American Journal of Medicine, 123(7), 612–624.
- Investigators speculate that history of a migraine headache is associated with increased cardiovascular risk. However, evidence to support this hypothesis is limited.
- For example, findings from a meta-analysis of 21 studies, which included 622,381 participants, revealed a relative risk of ischemic stroke 2.41 times higher among migraine sufferers (95% CI, 1.81 to 3.20) compared to those without migraines even when controlling for confounders such as hypertension, smoking, cholesterol, and oral contraceptive use. However, the heterogeneity of the samples among these studies was low.
- The pooled adjusted hazard ratio of ischemic stroke from three studies was 1.52 times higher among migraine sufferers (95% CI, 0.99 to 2.35) compared to those without migraines. The heterogeneity among these three studies was high.
- Discomfort: Timing, character, location, duration, precipitating factors
- Nutrition: Food and fluid intake; understanding of dietary restriction
- Medication management: Understanding of drug therapy, response to medications
- Response to alternative treatments: Success of treatment, interest in developing other, nontraditional management strategies
Discharge and home healthcare guidelines
Teach the patient how to maintain lifestyle changes with regard to rest, nutrition, and medication management. Make sure the patient and family understand all aspects 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.
Patient discussion about Migraine Headache
Q. what is migraine???
Q. What the reasons to the migraine?
Q. What Is a Migraine? I have these headaches and my doctor says it sounds like I’m suffering from migraines. What exactly are migraines?
A migraine is a situation that generally combines a headache with certain characteristics, such as increased sensitivity to light, pulsating pain, usually only one sided and that lasts no longer than 72 hours. It is usually a phenomenon that runs in the family, and sometimes can be very difficult to overcome. Here are some tips about dealing with a migraine- http://www.5min.com/Video/How-to-Treat-Headaches-21797151