A migraine is a type of headache that is severe and unrelenting in nature. It is usually characterized as a throbbing or pulsing on one side of the head and is often accompanied by nausea, vomiting, dizziness, abdominal discomfort, and light and sound sensitivity.
The unilateral pain often spreads to involve the entire head. Migraine attacks may last from four to seventy-two hours and may be so severe that it interrupts with daily activities.
Factors that precipitate migraine headaches include atmospheric changes, use of oral contraceptives, menstruation, food choices and hunger, and stress.
It has also been found to be more common in women. While the exact cause of migraine headaches is still not yet fully understood, research suggests that it is related to changes in blood flow and metabolism in the brain.
Serotonin is noted to be reduced during migraine headaches, leading to a release of neuropeptides that travel to the brain’s meninges. This causes inflammation and severe vascular pain.
Phases of Migraine Headaches
Migraine headaches may be subclassified into two types: migraines with aura, and migraines without aura. Migraines with aura have four phases: prodrome, aura, headache, and recovery.
- Prodrome Phase. The prodrome phase occurs hours or days prior to a migraine. The patient experiences depression, irritability, cold intolerance, cravings, change in appetite and activity level, polyuria, and changes in bowel movement. The same prodrome is usually experienced with each migraine.
- Aura Phase. The aura phase occurs within an hour prior to the headache phase. The patient experiences focal neurologic symptoms such as hemianopia, visual disturbances, numbness and tingling, confusion, weakness, drowsiness, and dizziness. Studies show that during the aura phase, there is a decrease in cerebral blood flow, with a loss in autoregulation and impairment in carbon dioxide responsiveness.
- Headache Phase. Due to the vasodilation and decrease in serotonin levels, the intensity of the throbbing headache increases over several hours. This is associated with photophobia, nausea, and vomiting.
- Recovery Phase. The recovery phase is also known as the termination or postdrome phase. In this phase, the pain gradually subsides. Physical exertion may increase the pain, and muscle contractions and aches become common. Exhaustion and mood swings may occur and the patient may rest for extended periods.
Signs and Symptoms of Migraine
- Throbbing, unilateral pain that later spreads
- Visual disturbances, i.e., photophobia, light flashes, bright spots
- Dizziness
- Nausea and vomiting
- Abdominal discomfort
- Fatigue, drowsiness
- Numbness, tingling
- Mild confusion
- Mood changes
Types of Migraine
- Depending on aura
- Migraine with aura – migraines with a warning sign
- Migraine without aura – migraines without warning signs
- Depending on duration
- Chronic migraine – migraines that occur at least 8 days per month for at least three months
- Episodic migraine – migraines that occur less than 8 days per month
- Migraine with brainstem aura – migraine with aura; previously called basilar-type migraine. It occurs with at least 2 neurological symptoms (i.e. slurring of speech, vertigo, tinnitus, double vision, ataxia, syncope, and pins and needles)
- Vestibular migraine – features vertigo, dizziness, or problems with balance in combination with other migraine symptoms
- Abdominal migraine – migraines that feature attacks of stomach pain and vomiting; without headaches
- Hemiplegic migraine – includes unilateral paralysis as part of the migraine attack
- Menstrual migraine – migraines with menstruation as a trigger; occurs during the menstrual period
- Medication overuse headache – results from continuous or frequent use of pain medications
Causes of Migraine
While the exact cause of migraine headaches is not yet fully understood, it is linked to the abnormal metabolism of serotonin in the cells of the brain. The rise in plasma serotonin precedes headaches, which dilates the cerebral vessels.
Triggers of Migraine
- Family history and familial tendency
- Age – usually begins during adolescence and peaks during the 30s
- Sex – women are thrice more likely to have migraines
- Hormonal changes – headaches may begin before or shortly after the first day of menstruation; changes during pregnancy; improves after menopause
Risk Factors related to Migraine
- Hormones – estrogen-related changes trigger headaches in women
- Drinks – alcohol and caffeine exacerbate migraines
- Stress
- Sleep changes – lack of or too much sleep can trigger migraines
- Sensory stimuli – bright lights, loud sounds, and strong smells can induce migraines
- Physical factors – intense physical activity can provoke migraines
- Medications
- Oral contraceptives
- Vasodilators
- Food and additives – aged cheeses, salty, and processed foods may trigger migraines; missing meals may also exacerbate symptoms. Foods that include aspartame and MSG may also contribute
Complications of Migraine
- Status migranosus – a migraine that lasts for more than 3 days; often occurs after taking too much headache medication
- Migranous infarction – also called migranous stroke; narrowed cerebral vessels cause depleted oxygen supply in the brain
- Migraine-triggered seizure – may happen during or post-migraine
Diagnosis of Migraine
Diagnosis of migraine headaches is usually done by a neurologist’s assessment. Health history is reviewed and physical and neurological examinations are done. An MRI or CT scan may be done as well.
Treatment for Migraine
Treatment is usually aimed at relieving the patient’s pain. These include pain relievers, triptans, ergotamine, opioids, and anti-nausea drugs.
Prevention of Migraine
Preventive management is aimed at reducing the frequency, severity, and duration of migraines. These include beta blockers, antidepressants, and anti-seizure drugs.
Nursing Care Plan for Migraines
Migraine Nursing Care Plan 1
Nursing Diagnosis: Acute Painrelated to the severe pulsating sensation of the head secondary to Migraine, as evidenced by the patient’s verbal report of throbbing pain on one side of the head that interferes with the patient’s daily routine, restlessness, facial grimace, and guarding behavior.
Desired Outcomes:
- The patient will report minimized discomfort.
- The patient will engage in relaxation techniques and distractions in line with the recommendations for his situation.
- The patient will be able to carry out daily routines without being hindered by pain or discomfort.
Nursing Interventions for Migraine with Acute Pain
Determine the size, characteristics, severity, triggers, and duration of pain. Observe gestures that suggest pain. Aids in identifying the type of headache and selecting the most appropriate interventions. Can also be used to gauge the effectiveness of the treatment.
Monitor the patient’s vital signs. During pain episodes, vital signs may change. Variations can show if the patient’s condition is getting better or getting worse.
Encourage and maintain bed rest throughout the acute phase. Improves relaxation while decreasing possible stimulation.
Determine the triggering circumstances. Stress, skipped meals, too much or too little caffeine, changes in the weather, tiredness, exposure to smoke or strong scents, and other factors can all be migraine triggers. Episodes can be reduced by assisting the patient in recognizing specific migraine triggers.
Administer pain medications as directed by the physician. Helps to reduce or control pain, which eases discomfort.
Plan the activities when pain medications are at their peak. Debilitating migraine pain can keep a patient from working, taking care of their family, or performing normal activities. Plan nursing activities and patient care when pain seems to be most manageable.
Provide or recommend headache-relieving methods that are not pharmaceutical, such as a cold compress, a place with low lighting, relaxation exercises like guided imagery or distraction, and other pleasant diversions. Effectively relieves headaches and other related issues.
Limit or stop vasoconstricting tendencies that exacerbate migraines, such as leaning over, coughing frequently, and straining at stools. Activities that induce cerebral vascular pressure make the migraine worse.
Migraine Nursing Care Plan 2
Nursing Diagnosis: Impaired Comfortrelated to associated symptoms secondary to Migraine, as evidenced by tiredness, irritability, patient’s verbal report of anxiety, and lack of sleep.
Desired Outcomes:
- The patient will convey better emotional comfort and relief.
- The patient will take part in techniques and treatments to enhance psychological and spiritual comfort.
Nursing Interventions for Migraine with Impaired comfort
Assess the impact of impaired comfort on the patient’s lifestyle. Analyze how the patient’s impaired comfort affects his capacity to develop connections, keep a job, and achieve goals. It may help guide interventions.
Evaluate the current coping mechanisms of the patient. Find out what the patient does to feel more comfortable. Does the patient use undesirable coping mechanisms, practice any religion, or have a supportive family? The patient might require a change of approach or more support.
Administer medications as indicated. Painkillers can help with discomfort that primarily impairs comfort. Comfort can be improved by taking additional medications, such as antiemetics for nausea, antihistamines for lightheadedness, and sleep aids.
Develop a dependable and trusting relationship with the patient. Open and honest communication is encouraged by a trusting relationship. Establishing a rapport helps improve adherence to the prescribed course of treatment.
Reduce noise and other stimulation. Comfort can be attained in a cool, calm environment with low light. Talk to the patient quietly and calmly as much as possible.
Recommend counseling or therapy consults. Headaches and uncomfortable feelings can be brought on by external stress and internal problems. Promote or offer chances to engage with a therapist who could be able to create coping mechanisms to manage emotional stress.
Migraine Nursing Care Plan 3
Nursing Diagnosis: Nausea related to overstimulation of medulla oblongata (nausea/vomiting center) secondary to Migraine, as evidenced by the patient’s verbal report of dizziness, nausea, vomiting, gagging sensation, and loss of appetite.
Desired Outcome: The patient will be able to control persistent nausea as evidenced by weight maintenance.
Nursing Interventions for Migraine with Nausea
Determine the degree of nausea, vomiting, and restricted dietary intake. To establish a baseline and assess the need for nutritional and fluid supplementation.
Recommend trying dry food products such as crackers and toast, as well as ice chips, sips of cold water, and ginger items when feeling nauseous. To improve appetite and lessen discomfort, also enhance hydration and lessen the discomfort caused by nausea.
Encourage a bland diet and limit the consumption of oily, spicy, and caffeinated foods and drinks. Refrain from eating dairy products, and fried, sugary, or greasy meals. To lessen stomach acidity, enhance food absorption, and mitigate nausea and vomiting.
Use antiemetics as prescribed. To eliminate and manage nausea and vomiting.
Regularly check the patient’s weight. To keep track of the nutritional status and treat any malnutrition or dehydration that may be present.
Instruct the patient to stay away from foods and odors that make them nauseous. To help minimize the risk of vomiting and nausea.
Educate the patient about natural remedies for nausea, such as taking deep breaths, guided imagery, and relaxation techniques. Help alleviate nausea and encourage autonomy.
Instruct the patient and the caregiver to get professional help if vomiting lasts more than 24 hours. Vomiting frequently has detrimental effects. Dehydration, electrolyte imbalance, and dietary deficits are consequences caused by this condition which can be avoided with prompt assessment.
Migraine Nursing Care Plan 4
Nursing Diagnosis: Risk for Falls related to the severe throbbing sensation of the head secondary to Migraine.
Desired Outcomes:
- The patient will be able to maintain safety as evidenced by the absence of falls and fall-related injuries.
- The patient will be able to carry out regular activities without falling.
- The patient will comprehend the significance of taking extra precautions to avoid falls.
Nursing Interventions for Migraine and Risk for Falls
Gather baseline vital signs and pay close attention to dizziness indicators. Subsequent readings can be compared using baseline data. Also, it will provide details on the patient’s usual figures while at rest.
Inspect the patient’s surroundings. Trip risks may raise the patient’s likelihood to fall. Making the surroundings familiar to the patient will improve the patient’s navigation.
Evaluate the capacity for carrying out daily tasks and offer assistance as necessary. The patient’s capacity to carry out simple duties can also be affected by severe migraine. The patient’s evolving care demands can be determined by recognizing the challenges in personal care.
Ensure that the patient’s surroundings are secured by doing the following:
- Maintain a clutter-free area.
- Stay off slippery floors.
- Provide sufficient lighting.
- Offer suitable footwear or slippers.
- Position the bed at the lowest level.
- Valuables must always be accessible.
To ensure safety and prevent trips and falls, the environment’s safety is essential.
Keep things that the patient uses frequently within reach. Things that are out of the patient’s reach may cause falls and injuries associated with falls.
Evaluate if pain medications are necessary. Individuals with severe migraines may have pain that causes them to move or walk uncomfortably, which increases their risk of falling.
Migraine Nursing Care Plan 5
Nursing Diagnosis: Disturbed Sensory Perception related to accompanying symptoms during acute attacks such as visual disturbances secondary to Migraine as evidenced by abnormal eye movement, clumsy behavior, sensitivity to light, sound, and scents, and verbal reports of dizziness and blurred vision
Desired Outcome: The patient will be able to function at the highest possible level, as demonstrated by his capacity for self-care, safe environment navigation, and productive activity participation.
Nursing Interventions for Migraine with Disturbed Sensory Perception
Assess aspects or devices that may assist the patient see better, such as spectacles, contact lenses, or bright or natural light. To choose a course of action, it is vital to have an understanding of the factors that can enhance the patient’s visual ability.
Inquire about the patient’s specific abilities, such as their capacity to read, watch television, have fallen in the past, or ability to self-medicate. To determine the degree of impairment experienced during migraine attacks and to assist in the planning of further interventions.
Ensure there is sufficient light. Patients with migraine tend to have poor vision and should use natural or halogen lighting to enhance their vision.
Put the call light, food tray, water, and other necessities within the patient’s sight or access. To maintain safety, minimize the likelihood of falls, and ensure a sense of autonomy.
Keep the bed in a low position with raised side rails as necessary. Side rails serve as a gentle reminder to the patient not to stand up on their own during migraine episodes and reduce the risk of falls.
Give the patient instructions to grip the chair’s arms before sitting on it and to feel for the seat on armless chairs or couches when they are experiencing migraine symptoms. These measures further minimize the possibility of falls and familiarize the patient with his environment. Encourage the patient to exercise caution at all times.
Administer pain medications as prescribed. Helps to reduce or control pain, which lessens the possibility of migraine symptoms such as sensitivity to light and sound, dizziness, and blurred vision.
Help the patient move as necessary. Dizziness and visual disturbances are frequently associated with migraines, which increases the risk of accidents.
Other Possible Nursing Diagnoses for Migraine
- Risk for electrolyte imbalance
- Risk for deficient fluid volume
- Dysfunctional gastrointestinal motility
- Fatigue
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
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