Headache Nursing Diagnosis and Nursing Care Plan

Headache Nursing Care Plans Diagnosis and Interventions

Headache NCLEX Review and Nursing Care Plans

Headaches are a common problem characterized by pain in the head or face. This sensation can be throbbing, continuous, sharp, or dull.

Medication, stress management, and biofeedback can all help in treating headaches.

Types of Headaches

There are over 150 kinds of headaches, depending on location, intensity, frequency, and cause. Headaches are divided into two main categories: primary and secondary headaches.

Primary headaches are not secondary or related to any medical condition. It is not considered to be a symptom of an existing medical condition.

The pain from primary headaches may put someone out of action, but these are not life-threatening. These types of headaches come from inflammation in parts of the body that are sensitive to pain, usually around the head and neck.

These areas include the nerves, blood vessels, and muscles. The types of headaches that are included in this category are:

  • Tension headache. A tension headache is the most common type of headache in adults and teenagers. The level of pain is mild to moderate and tends to be constant but not pulsating. felt on both sides of the head, or bilateral, and gets better after taking an over-the-counter pain reliever. Worsening when doing routine activities like bending over and walking upstairs. The most common symptoms of tension headache are pounding and throbbing pain, which can last from 4 to 72 hours. It is often associated with other symptoms like nausea, vomiting, sensitivity to light, noise, or smell, loss of appetite, and stomach or abdominal pain. In children, migraine is usually presented with the following symptoms: dizziness, blurry vision, looking pale, fever, and stomach pain. Some children also experience vomiting.
  • Cluster headache. This is the most severe type of primary headache that usually happens in a group or cluster, most of the time during the spring or fall season. The pain may last until 15 minutes to 3 hours and might occur once to three times a day during a cluster period. The cluster period is usually two weeks to three months. The kind of pain is intense, pulsing, and consistent, with a burning or piercing sensation felt behind or around one eye. in the region of pain, drooping of the eyelid, eye redness, constriction of the pupil, and teary eyes. 
  • New daily persistent headache. In this type of headache, there’s a sudden onset of pain that doesn’t resolve within 24 hours and recurs almost every day. This type of headache is not as common as others. However, it affects routine and daily activities. Most commonly, headaches develop among those without a previous history of headaches.
  • Sinus headache. This is secondary to a sinus infection and is related to nasal congestion and inflammation in the sinus area. Headaches worsen with a sudden movement of the head or during straining. Deep pain is also felt in the cheekbone and forehead. Other symptoms are facial swelling, mucus discharge, fever, facial swelling, and bad taste. 
  • Medication overuse headache. Frequent taking of pain relievers for headaches is the cause of this type of headache. Overuse of medication can increase the frequency of headaches, and the patient may experience more days with pain than without. Most of the time, the pain gets worse in the morning.

Secondary Headaches

Secondary headaches are headaches related to other medical conditions. They trigger areas in the head and neck that are sensitive to pain. Secondary headaches are not more common than primary headaches. However, they can be more severe considering that they can be a warning sign of an existing condition, which may include:

  • brain tumors
  • head injury
  • high blood pressure
  • aneurysm
  • infection
  • medication overdose
  • nasal congestion
  • trauma
  • injury to the neck or brain
  • tumor

Risk Factors for Headache

A risk factor is something that increases the possibility of having a disease. Headaches can be triggered by several factors, depending on which type of headache the patient has.

  1. Tension Headache
    • Lifestyle – increased stress level, fatigue, anger, and not having enough sleep
    • Existing health conditions – depression and anxiety have been connected to tension headaches.
  1. Migraines
    • Lifestyle – the most common lifestyle factors are skipped meals, fasting, specific food and drinks, trouble sleeping, stress, and drinking alcohol.
    • Existing health conditions
    • Medications  -hormone replacement therapy and hormonal contraceptives, pain relievers that are used frequently or nearly on a daily basis
    • Other factors such as menstruation period, weather or altitude changes, strong lights, loud music, environmental noise, and strong smells like perfume.
  1. Cluster headache
    • Lifestyle- Cluster headache is more common in people who smoke.
    • Health problems- Similar to other types of headaches, depression, and anxiety are also linked to cluster headaches.
  1. Sinus headache
    • Health problems – some conditions lead to mucus production, swelling in the tissue lining of the nose, pain, and pressure. The following increases the risk of these problems:
    • Allergies – This includes allergies to pollen, pollution, and seasonal related
    • Nasal congestion
    • Common colds
    • Upper respiratory infection
    • Nasal polyps
    • Deviated septum
    • Cystic fibrosis
    • History of sinus surgery
    • Low immune system
    • Trauma or injuries that affect and block sinus passages.

Diagnosis of Headache

 1. Physical assessment. An accurate assessment is needed to have the right diagnosis and an accurate treatment plan will be designed. The patient will be asked about the symptoms they experience, the frequency of headaches that happen, their severity, the location of the pain, and what relieves them from the pain. The doctor will also obtain a full medical history of the patient, including the existing medical condition, history of illness, allergies, maintenance medicine, and others. A physical examination will be done afterward.

In diagnosing a headache, one important point is to identify the category it belongs to. If the headache is of the primary or secondary type, these steps may be taken for proper diagnosis.

2. Headache diary.  This is a tool that logs important details about the headache. The following will be accurately recorded in this diary: the frequency, duration, and severity of headaches over time. It also contains information such as the pattern, triggering factors, medication taken, and the response to it. It helps the physician make the right diagnosis and an effective treatment plan.

3. Headache trigger tracker. This tool assists in determining what causes and worsens headache. It can be food, drinks, events, and others. With this tracker, the patient can be aware of their triggers and the doctor can better manage the headache.

4. Neurological Exam. The doctor will also check the following: muscle strength and coordination, reflexes, sensation, mental status, and cranial nerve function.

5. Lumbar puncture. A lumbar puncture or spinal tap is recommended to identify if there’s an occurrence of bleeding or the presence of bacterial or fungal infection.

6. Nasal endoscopy. This is an examination of the nasal and sinus passages. This is to check if there’s inflammation in that area and also for nasal tumor growth.

7. Imaging. Imaging diagnostic procedures of the head such as CT Scans and MRI can be done to evaluate if the headache is related to a problem with the central nervous system. These tests can result in cross-sectional images of the brain, and abnormalities or problems can be assessed.

Complications of Headache

Generally, the complications of primary headache are not because of the headache itself, but rather secondary to treatment overuse. One known example is the frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) that can lead to stomach pain and gastrointestinal bleeding.

Rebound headaches, or medication-overuse headaches, are common complications of primary headaches. This happens if painkillers are taken too frequently. The treatment is to discontinue taking the medicine. However, some types of medicine for headaches can result in withdrawal symptoms. Therefore, the treatment must be under the supervision of a healthcare professional.

Other complications of headaches include:

  • Status migrainosus. This is an episode of migraine, but the pain is persistent and lasts for more than 3 days. It may result to feeling drained or even disabled. In this kind of pain, the patient cannot get enough sleep and keep from throwing up, which increases the risk of dehydration. The patient may require intravenous medication and need to be brought to the hospital.
  • Migrainous infarction. This involves the narrowing of blood vessels to the brain occurs and leads to a reduction in oxygen supply. It usually happens all of a sudden, with an aura and a set of unusual sensations like a reduction in light flashes, blind spots, and tingling of hands or face.
  • Persistent aura without infarction. There is migraine with an aura that sometimes lingers for more than a week. The signs are close to those of a stroke, but there is no actual bleeding in the brain.
  • Seizures. A migraine-triggered seizure occurs during or after a migraine with aura.

Treatment for Headache

The doctor will first rule out the underlying cause of the headache before prescribing any medication. Several treatments are available on the market to relieve pain and treat headaches.

  • Acute treatment. These medications are given to help treat headaches and their symptoms after they start. These include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Nasal spray is commonly used for nasal congestion, common colds, and sinusitis.
  • Preventive measures. These are taken regularly to prevent headache attacks and worsening of symptoms. These may include antihypertensive drugs, antidepressants, antiseizure and antipsychotic medications.

Prevention of Headaches

The following steps may prevent symptoms of headaches:

  • Identify triggers and avoid them as much as possible. Keep a headache tracker to record and monitor attacks.
  • Learn stress management techniques like meditation, yoga, and deep breathing exercises.
  • Have a regular eating schedule.
  • Have enough rest.
  • Exercise regularly.
  • Increase oral fluid intake.

Nursing Diagnosis for Headache

Nursing Care Plan for Headache 1

Acute Pain

Nursing Diagnosis: Acute Pain related to headache secondary to alcohol withdrawal as manifested by tremors, anxiety, stomach pain, restlessness, and increased heart rate.

Desired Outcomes:

  • The patient will verbalize reduction of pain with acceptable pain control at a level of 4 out of 10.
  • The patient will exhibit improvement in heart rate within the normal range, as well as blood pressure and respiration.
  • The patient will show the benefits of using applicable diversional activities and relaxation skills.
Nursing Interventions for HeadacheRationale
Perform a thorough assessment of pain. Identify the following details: characteristics, onset, period of time, frequency, quality, and intensity. Also included in the assessment is the history of pain.The patient is the most accurate source of information about the pain they have. It is the gold standard in the assessment of pain, for they can provide relevant details such as pain severity and length of time. It is also important to determine the history of headache: previous pain treatment or management done, the effectiveness of previous treatment, and if there are any allergies or side effects to medications.
Evaluate the site of the pain by asking the patient to point to the location that has discomfort.Making use of charts or drawings of the body can guide the patient and the nurse to identify the exact location of the pain. Especially among patients with a limited vocabulary or in children, they can pinpoint the location of the pain.
Provide actions to alleviate pain before it gets worse.When a higher dose is required, pain medications should be administered before the onset of pain or before it worsens.
Teach the patient non-pharmacologic pain management for headache.Nonpharmacologic techniques in the management of pain include physical, cognitive, and behavioral approaches and lifestyle pain management.
Provide nursing care during the peak effects of pain relievers.Oral pain relievers peak within 60 minutes. Doing nursing tasks at the peak of a pain reliever increases comfort and compliance in the care of patients.
Assess the effectiveness of pain medications as prescribed by the doctor and monitor for any signs and symptoms of side effects.Evaluation of the effectiveness of pain relievers must be done per individual. Absorption and metabolism differ from one person to another. 

Nursing Care Plan for Headache 2

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to headache secondary to hypertension as evidenced by fatigue, elevated blood pressure in response to activity, and difficulty breathing.

Desired Outcomes:

  • The patient will participate in daily activities with a lower incidence of headaches, difficulty breathing, chest pain, excessive sweating, and dizziness.
  • The patient will improve blood pressure within their normal range.
  • The patient will make use of the recognizable techniques to improve activity tolerance.
  • The patient will verbalize a significant increase in activity tolerance.
  • The patient will exhibit a decline in physiological signs of intolerance.
Nursing Interventions for HeadacheRationale
Assess the patient’s medical history.They provide accurate information required in planning treatment and activities.
Assess the patient’s limitations to activity or level of deficit in light of their usual status.It gives a comparative baseline and data about the needed instructions and procedures regarding the quality of life.
Evaluate the patient’s participation in activities. Monitor the patient’s heart rate and blood pressure during and after activity. Observe any signs of chest pain, difficulty breathing, extreme tiredness, sweating, dizziness, and weakness.The mentioned parameters help to evaluate the physiologic responses to the stress of activity and the benchmark of overexertion.
Observe the emotional and psychological components that affect the present situation.Too much stress or feeling depressed may increase the effects of a disease, or depression might be secondary to a lack of activity.
Advise the patient about energy-conserving strategies like using a chair​​ when showering, sitting when brushing teeth or combing hair, and doing activities at a slower pace.These energy-saving techniques save energy by lowering their expenditure and balancing the oxygen supply and demand of the body.
Advise the patient to perform activities in a gradual manner and do self-care when tolerated. Provide assistance.Gradual increases in activities prevent an abrupt increase in cardiac workload. Giving assistance only when needed to promote independence in performing activities.

Nursing Care Plan for Headache 3

Impaired Comfort

Impaired Comfort related to headache secondary to nerve disorder, as evidenced by pain, lack of sleep, rapid and shallow breathing, and anxiety.

Nursing Stat Facts
Nursing Stat Facts

Desired Outcomes:

  • The patient will verbalize an improved pain score of less than 3 out of 10 on a pain scale.
  • The patient will exhibit the proper way of using a coping mechanism when feeling stressed.
  • The patient will express a feeling of improved comfort.
Nursing Interventions for HeadacheRationale
Evaluate the risk factors contributing to discomfort and get a baseline information on each item.Having this accurate information will give a good start for the healthcare team in using it to raise the patient’s level of comfort.
Check for any barriers to communication.Factors such as language barriers, sensory impairment, trust issues, and others can hinder the patient from expressing their feelings and concerns.
Monitor the patient’s level of pain with the use of appropriate pain scales. Any signs of pain or discomfort should be properly addressed by the healthcare team. Proper assessment will establish what level of pain is acceptable and what will be the goal level of pain control.
Establish a reliable and trusting environment with the patient.Achieving patient trust can help to administer treatment plans in an easier manner. The patient can open up their concerns to the healthcare staff with confidence and reliance.
Make changes in the environment to the patient’s comfort. This includes taking away noisy equipment or appliances, balancing lighting in the room, providing earplugs and eye covers, and regulating the temperature in the room.By providing a conducive environment for the patient, the nurse will promote a feeling of control and comfort.
Teach several relaxation techniques that may lessen a patient’s discomfort. Examples are guided imagery or visualization, deep breathing exercises, meditation, and music therapy.These activities will shift the attention away from the present experience of pain and discomfort and can focus on more pleasant experiences.
Administer pain medication as prescribed.to improve feelings of discomfort secondary to pain and prevent worsening of the patient’s condition.

Nursing Care Plan for Headache 4

disturbed sleep pattern.

Difficulty falling asleep, fatigue, feeling restless, waking up in the middle of the night, and morning headache are all symptoms of a disturbed sleep pattern caused by migraine headache.

Desired Outcomes:

  • The patient will exhibit an improved sleeping pattern.
  • The patient will verbalize having improved and more restful sleep.
Nursing Interventions for HeadacheRationale
Evaluate the patient’s sleeping pattern and take note of any significant changes. Also include the frequency of sleep in a day, the number and time of awakenings in the middle of the night or sleep. The incidence of fatigue, weakness, and inactivity.This is to correlate the altered sleeping patterns with the guidelines or indicators of other disorders. Having this information helps create a patient care plan or intervention to rectify sleeping problems. In some cases, patients will experience frequent sleep during the day. This may cause tiredness and a feeling of restlessness at the end of the day and delay sleep time at night.
Monitor any factors that affect the quality of sleep. This includes the use of alcohol, medications, or caffeine.Identifying patients’ intake of alcohol, medication, or caffeine would help to trace the problem causing sleep deprivation. Some  older patients may experience an increased need to urinate during the rest period.
Provide the patient with an environment that is relaxing, comfortable, free of noise and distractions.To encourage a good quality of sleep by removing external stimuli that may cause awakenings during the night.
Advise other sleep support techniques such as drinking warm milk, taking warm baths before bed, and having extra covers and linens.To improve a patient’s sense of comfort and relaxation. It also improves any probable disturbance.
to necessary, provide medication that relieves pain as prescribed.To establish better sleep and comfort and promote a complete sleep cycle.

Nursing Care Plan for Headache 5

Nausea

Nursing Diagnosis: Nausea related to headache secondary to persistent migraine as manifested by gagging sensation, sour taste in the mouth, abdominal pain, and increased swallowing.

Desired Outcomes:

  • The patient will express relief from nausea.
  • The patient will identify the helpful ways to prevent nausea.
Nursing Interventions for HeadacheRationale
Identify what triggers migraine and take note of the risk factors. Evaluating the patient’s cause of migraine will help in planning of interventions to be used. Also, if the triggering factor was identified, the treatment may not be needed.
Evaluate the characteristics of migraine: HistoryDurationFrequencySeverityPrecipitating factors Medications  A comprehensive assessment can help to identify the appropriate intervention to solve or lessen the problem.
Monitor the patient’s hydration status, intake and output, everyday weight, blood pressure, and skin elasticity.Nausea is commonly associated with vomiting and can affect the patient’s hydration status caused by fluid loss.
Guide the patient in preparation for diagnostic testing.A series of tests may be required to identify the precipitating factors, CT scan, MRI, and upper gastrointestinal tract study.
Keep the patient hydrated.A constant supply of fluids to the body may reduce the risk of dehydration and may prevent worsening of a patient’s pain.
Teach the patient nonpharmacological techniques that may control migraine and nausea, such as relaxation, music therapy, guided imagery, and deep breathing exercises.These techniques can help patients relieve pain and discomfort.
Provide a small amount of food frequently. Examples are dry foods like crackers and toast, bland and simple foods like soup, rice, bananas, and gelatin.To maintain nutritional status and prevent exacerbation of nausea. These types of foods are recommended for patients experiencing nausea as they are proven to be effective in reducing symptoms.
Administer pain medication and antiemetics as prescribed.These medications are given to reduce pain, discomfort, nausea, and vomiting.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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