Chest pain or signs of cardiac ischemia after triptan administration — hold the medication and notify the provider.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A client presents with the sudden onset of the worst headache of their life, neck stiffness, and photophobia. The nurse suspects which neurologic emergency?
Answer: A. A sudden, severe headache often described as the worst headache of one's life, accompanied by nuchal rigidity (neck stiffness) and photophobia, is the classic presentation of a subarachnoid hemorrhage, frequently from a ruptured cerebral aneurysm. This is a neurologic emergency. A TIA causes transient deficits without this headache, an absence seizure causes staring spells, and a tension headache is gradual and milder.
Question 2 of 3
A client receiving an IV nitroglycerin infusion for unstable angina reports a throbbing headache. The nurse understands that this finding indicates which of the following?
Answer: B. Headache is a very common and expected effect of nitroglycerin because the drug causes vasodilation of cerebral vessels; it is not a sign of an allergic reaction or overdose. The infusion is typically continued and the headache managed with acetaminophen unless hypotension develops. It does not signal that the drug should be stopped immediately or that it is ineffective.
Question 3 of 3
A client receiving chemotherapy has a platelet count of 9,000/mm3 and develops a sudden severe headache with confusion. What is the nurse's first action?
Answer: A. With profound thrombocytopenia, a sudden severe headache and altered mental status may indicate intracranial hemorrhage, a life-threatening emergency. The nurse should notify the provider immediately so urgent evaluation and platelet transfusion can occur. Administering oral analgesics, encouraging activity, or simply waiting would delay critical care.
Keep the streak going with more questions like these, each with a full rationale.
What is cluster headache?
They are accompanied by autonomic signs on the same side such as tearing, nasal congestion, eyelid drooping, and facial sweating. Attacks are short (15 minutes to 3 hours), often wake the patient at night, and tend to occur at the same time each day. They are more common in men.
Key points to remember
- Severe, sharp, unilateral periorbital pain that occurs in clusters of daily attacks lasting 15 minutes to 3 hours, often at the same time each day or night.
- Ipsilateral autonomic features: lacrimation (tearing), nasal congestion/rhinorrhea, ptosis, miosis, conjunctival redness, and facial sweating on the affected side.
- During attacks patients are typically restless and pace, unlike migraine sufferers who prefer to lie still.
- Acute treatment: 100 percent oxygen by nonrebreather mask and subcutaneous or intranasal sumatriptan.
- Alcohol, nicotine, and strong odors are common triggers during a cluster period and should be avoided.
Signs & symptoms
- Excruciating unilateral eye/temple pain
- Ipsilateral tearing, nasal congestion
- Ptosis + miosis (Horner's)
- Restless, paces (vs migraine)
Nursing priorities
- Administer high-flow 100 percent oxygen via nonrebreather mask at attack onset as ordered.
- Give prescribed subcutaneous or intranasal triptan promptly for acute relief.
- Provide a calm environment and allow the patient to move or pace, as restlessness is common.
- Assess and document attack timing, duration, frequency, and triggers.
- Administer preventive medications (verapamil, corticosteroids) as ordered during cluster periods.
Patient teaching
- Avoid alcohol, nicotine, and strong odors entirely during a cluster period, as they can trigger attacks.
- Use 100 percent oxygen and prescribed abortive medication at the first sign of an attack.
- Take preventive medication consistently during cluster cycles even when feeling well.
- Keep a headache log noting timing and triggers to guide treatment.
- Maintain a regular sleep schedule, since attacks often occur during sleep or at predictable times.
Red flags: report now
- Chest pain or signs of cardiac ischemia after triptan administration — hold the medication and notify the provider.
- A new headache pattern, headache with neurologic deficits, or 'worst-ever' sudden headache that does not fit the usual cluster pattern.
References
Clinical references for this topic
