Pain is typically unilateral, pulsating/throbbing, and worsened by physical activity, lasting 4 to 72 hours.
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 migraine headache?
Some patients experience an aura (visual or sensory warning) before the headache begins. Attacks last 4 to 72 hours and are commonly triggered by stress, certain foods, hormonal changes, lack of sleep, and bright lights. Management focuses on aborting acute attacks and preventing recurrence.
Key points to remember
- Pain is typically unilateral, pulsating/throbbing, and worsened by physical activity, lasting 4 to 72 hours.
- Associated symptoms include nausea, vomiting, photophobia, and phonophobia; some patients have a preceding aura such as flashing lights or zigzag lines.
- Abortive (acute) treatment: triptans (sumatriptan) and ergotamines cause vasoconstriction and are taken at onset; NSAIDs and antiemetics are adjuncts.
- Triptans and ergotamines are contraindicated in coronary artery disease, uncontrolled hypertension, and pregnancy because of their vasoconstrictive effect.
- Preventive drugs (beta-blockers like propranolol, topiramate, amitriptyline, CGRP antagonists) are used when attacks are frequent.
Signs & symptoms
- Unilateral throbbing/pulsating pain
- Aura: flashing lights, zigzags
- Photophobia + phonophobia + N/V
Nursing priorities
- Provide a dark, quiet, cool environment and minimize light, noise, and movement during an attack.
- Administer abortive medication early at the first sign of a migraine for best effect.
- Apply cool cloth to the forehead and encourage rest in a comfortable position.
- Assess pain characteristics, triggers, and response to treatment, and help the patient keep a headache diary.
- Administer antiemetics as needed and monitor hydration if vomiting occurs.
Patient teaching
- Identify and avoid personal triggers such as aged cheese, red wine, caffeine, MSG, stress, and skipped meals using a headache diary.
- Take abortive medication at the very first sign of a migraine rather than waiting.
- Rest in a dark, quiet room during attacks and maintain regular sleep, meals, and hydration.
- Do not exceed prescribed triptan/ergotamine dosing to avoid medication-overuse (rebound) headaches.
- Report headaches that change in pattern, become more severe, or are accompanied by new neurologic symptoms.
Red flags: report now
- A sudden 'worst headache of my life,' headache with fever and stiff neck, or new focal deficits — these suggest hemorrhage, meningitis, or stroke, not a typical migraine.
- Chest pain, tightness, or signs of coronary ischemia after taking a triptan or ergotamine — hold the drug and notify the provider.
References
Clinical references for this topic
