Nursing Care Plan on Headache and Migraine

Headache and Migraine 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. 

Tension-type Headache

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. 

Cluster Headache

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 Headache 

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
• Fatigue
• 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.

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 Assessment

Headaches and migraines are common neurological conditions that significantly impact patients’ quality of life. Nurses play a crucial role in the assessment of these conditions. Through thorough evaluation, patient education, and individualized care plans, nurses can help alleviate symptoms and improve patient outcomes.

Patient History

A comprehensive patient history is the cornerstone of effective headache and migraine management. Nurses should gather detailed information about the patient’s headache patterns, including:

• Onset: When did the headaches or migraines start?
• Frequency: How often do they occur?
• Duration: How long do the headaches or migraines last?
• Intensity: How severe are the symptoms?
• Triggers: Are there any identifiable triggers such as stress, certain foods, or environmental factors?
• Associated Symptoms: Are there accompanying symptoms like nausea, vomiting, visual disturbances, or sensitivity to light and sound?
• Family History: Is there a family history of headaches or migraines?

Physical Examination

Nurses should perform a thorough physical examination to identify any underlying conditions or complications. This includes:

• Vital Signs: Monitoring blood pressure, heart rate, and temperature.
• Neurological Assessment: Evaluating cranial nerve function, motor skills, sensory perception, and coordination.
• Palpation: Checking for tenderness or abnormalities in the head, neck, and shoulders.

Diagnostic Testing

Depending on the patient’s history and physical examination findings, nurses may facilitate diagnostic testing, such as:

• Imaging: MRI or CT scans to rule out structural abnormalities.
• Electroencephalogram (EEG): To assess brain activity, especially if seizures are suspected.
• Blood Tests: To identify metabolic or infectious causes.

Nursing Interventions

By educating patients, managing symptoms, coordinating care, and providing psychosocial support, nurses ensure that patients with headaches and migraines receive holistic and compassionate care, ultimately enhancing their quality of life.

Pharmacological Management

Nurses play a key role in administering and managing medications for headache and migraine relief. This may include:

• Acute Treatment: Administering pain relief medications such as NSAIDs, triptans, or antiemetics during headache or migraine episodes.
• Preventive Treatment: Prescribing medications like beta-blockers, anticonvulsants, or antidepressants to reduce the frequency and severity of migraines.

Nurses should educate patients about the correct usage, potential side effects, and the importance of adherence to prescribed medication regimes.

Non-Pharmacological Interventions

In addition to medication, nurses can implement various non-pharmacological interventions to manage headaches and migraines, including:

• Relaxation Techniques: Teaching patient’s techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation to reduce stress and tension.
• Hydration: Encouraging adequate fluid intake to prevent dehydration, a common headache trigger.
• Dietary Adjustments: Advising patients to avoid foods and beverages that are known headache triggers, such as caffeine, alcohol, and processed foods.
• Sleep Hygiene: Promoting healthy sleep habits, including maintaining a consistent sleep schedule and creating a restful sleeping environment.
• Physical Activity: Encouraging regular exercise to improve overall health and reduce headache frequency.

Patient Education

Educating patients about headache and migraine management is essential for empowering them to take control of their condition. Nurses should provide information on:

• Trigger Identification: Helping patients recognize and avoid headache triggers.
• Symptom Management: Teaching patients how to manage symptoms effectively during an episode.
• When to Seek Help: Advising patients on when to seek medical attention, such as in cases of sudden severe headaches, changes in headache patterns, or neurological symptoms.

Coordination of Care

Nurses act as liaisons between patients and other healthcare providers, ensuring seamless care coordination:

• Referral to Specialists: Facilitating referrals to neurologists, pain specialists, or other relevant healthcare providers based on the patient’s needs.
• Follow-Up Care: Scheduling follow-up appointments and ensuring that patients adhere to prescribed treatment plans and monitoring.

Psychosocial Support

Headaches and migraines can be distressing and impact patients’ mental health. Nurses provide essential psychosocial support by:

• Emotional Support: Offering reassurance and empathetic listening to address patient concerns and fears.
• Counselling: Providing counselling or referrals to mental health services if needed, especially for patients with chronic or severe conditions.

Nursing Care Plans

Once the nurse identifies nursing diagnoses for a migraine or headache, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for a migraine or headache.

Acute Pain

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

Related to:

• Pressure, throbbing, or aching to the temples, eyes, sinuses, or base of the skull
• Migraine episode

As evidenced by:

• Guarding or protective behavior
• Restlessness
• Positioning to ease pain 
• Increased heart rate
• Facial grimace
• Reports of pain 
• Flat affect
• Loss of appetite

Expected Outcomes:

• 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

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.

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.

Deficient Knowledge

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

Related to:

• Inadequate access to resources
• Inadequate awareness of resources
• Lack of information 
• Inadequate participation in care planning
• Lack of interest/motivation
• Misinformation

As evidenced by:

• Inaccurate follow-through of instructions 
• Inaccurate statements about a topic
• Poor control of symptoms

Expected Outcomes:

• 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

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.

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.

Impaired Comfort

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

Related to:

• 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 
• Fatigue
• Difficulty relaxing
• Irritability

Expected Outcomes:

• 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

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.

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.

Nursing Diagnoses and Rationales for Headache and Migraine

1. Acute Pain

Rationale: Headaches and migraines often present with severe, acute pain that can significantly impact a patient’s quality of life. This pain is typically throbbing and can be accompanied by nausea, vomiting, and sensitivity to light and sound. Addressing acute pain through medication management, such as the use of analgesics or triptans, and non-pharmacological interventions like relaxation techniques, cold compresses, and a quiet, dark environment can help alleviate symptoms. Regular pain assessments and adjustments to the pain management plan are essential to ensure effective relief.

2. Deficient Knowledge

Rationale: Patients and their families may lack understanding about the triggers, management, and prevention of headaches and migraines. Educating patients on identifying and avoiding personal triggers, recognizing early symptoms, and using prescribed medications correctly can empower them to manage their condition better. Providing written materials and one-on-one counseling sessions can help address this knowledge deficit and reduce anxiety related to the condition.

3. Anxiety

Rationale: The unpredictable nature and intensity of headaches and migraines can lead to significant anxiety and fear of future episodes. This anxiety can exacerbate symptoms and reduce the effectiveness of treatment. Offering emotional support, teaching stress management techniques, and providing information about the condition and its treatment can help alleviate anxiety. Encouraging patients to express their feelings and concerns can also provide valuable insights for personalized care.

4. Ineffective Coping

Rationale: Chronic headaches and migraines can affect a patient’s ability to cope with daily activities and responsibilities, leading to feelings of frustration and helplessness. Assessing the patient’s coping mechanisms, providing support groups, and teaching effective coping strategies such as time management and relaxation techniques can enhance their ability to manage the condition. Encouraging a healthy lifestyle with regular exercise, balanced nutrition, and adequate sleep can also support overall well-being.

5. Sleep Disturbance

Rationale: Headaches and migraines can disrupt sleep patterns, leading to insufficient rest and exacerbating symptoms. Assessing the patient’s sleep habits, promoting good sleep hygiene practices, and managing pain effectively before bedtime can improve sleep quality. Creating a comfortable sleep environment and encouraging relaxation techniques before sleep can also help manage sleep disturbances.

6. Impaired Physical Mobility

Rationale: Severe headache pain can limit a patient’s ability to perform daily activities, leading to impaired physical mobility. Assessing the patient’s physical limitations, providing assistive devices if necessary, and encouraging gradual activity can help maintain mobility. Coordinating with physical therapy and occupational therapy services can also provide additional support to improve physical function and independence.

7. Risk for Self-Care Deficit

Rationale: During migraine episodes, patients may be unable to carry out self-care activities due to debilitating pain and associated symptoms. Assessing the patient’s ability to perform self-care, providing assistance as needed, and developing a plan for periods of reduced function are crucial. Educating patients and caregivers on strategies to manage during acute episodes can help ensure that self-care needs are met.

8. Risk for Medication Overuse

Rationale: Patients with chronic headaches and migraines may be at risk for medication overuse, leading to rebound headaches and increased frequency of headaches. Monitoring medication usage, educating patients on the risks of overuse, and developing a comprehensive pain management plan that includes non-pharmacological interventions are essential. Regular follow-up appointments to reassess pain and medication effectiveness can help prevent overuse.

REFERENCES

1. 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
2. Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, PhD, FAADN, CNE. 2020. Elsevier, Inc.
3. Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
4. 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
5. Migraine vs. Headache: How to Tell the Difference. Penn Medicine. https://www.pennmedicine.org/updates/blogs/health-and-wellness/2019/november/migraines-vs-headaches
6. Pescador Ruschel MA, De Jesus O. Migraine Headache. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/

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