Migraine

Migraine Nursing Care Plans Diagnosis and Interventions

Migraine NCLEX Review Care Plans

Nursing Study Guide on Migraine

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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

  1. Depending on aura
    1. Migraine with aura – migraines with a warning sign
    1. Migraine without aura – migraines without warning signs
  2. Depending on duration
    1. Chronic migraine – migraines that occur at least 8 days per month for at least three months
    1. Episodic migraine – migraines that occur less than 8 days per month
  3. 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)
  4. Vestibular migraine – features vertigo, dizziness, or problems with balance in combination with other migraine symptoms
  5. Abdominal migraine – migraines that feature attacks of stomach pain and vomiting; without headaches
  6. Hemiplegic migraine – includes unilateral paralysis as part of the migraine attack
  7. Menstrual migraine – migraines with menstruation as a trigger; occurs during the menstrual period
  8. 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

Possible Nursing Diagnoses

Risk for electrolyte imbalance

Risk for deficient fluid volume

Dysfunctional gastrointestinal motility

Fatigue

Risk for falls

Nausea

Acute pain

Impaired comfort

Nursing Assessment

InterventionRationale
Complete the patient’s general data and history using the standard hospital forms. Pertinent data to be included are:
Name
Age
Gender
Marital Status
Religion
Address
Chief Complaint
History of Present Illness
Past Medical History
Personal and Social History
Family History
Obstetric history for females
Sexual history
Physical Examination findings
Admitting Impression
A complete history and physical examination ensure that all possible causes of failure to thrive are covered. Some data may appear irrelevant at first but may turn out to be contributory to the diagnosis and management.
Get the patient’s consent for medical intervention and care and explain the reason for each.Patients become more cooperative with their treatment plans if they know about what’s going on.
Obtain vital signs such as blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, height, and weight.These vital signs are the basic indicators of underlying pathologic processes. Any derangement will show up as abnormal values and point to the possible etiology of the condition.
Obtain a list of medications that the patient is currently taking including details such as dosage, drug strength, frequency, brand names, and status of compliance.Some medications may contribute to the migraines that the patient is experiencing, i.e., oral contraceptives, non-steroidal anti-inflammatory drugs, pain medications.
Check the results of the initial lab tests and refer to the physician.Baseline values of laboratory tests add valuable data to the initial impression generated from history and physical examination.
Bring the patient for imaging studies such as MRI and CT scan.Like the laboratory tests, imaging aids in the diagnosis of the patient’s underlying condition.

Nursing Planning and Intervention

InterventionRationale
Educate the patient on lifestyle and dietary modifications that may be applied.Certain food products trigger and exacerbate migraine headaches. Alcohol, nitrites, caffeine, and nicotine may precipitate headaches.
Monitoring intake and output.Monitoring of occurrences of vomiting and diarrhea is essential in identifying the need for fluid and electrolyte replacement.
Educate the patient in non-pharmacologic measures to relieve pain.While the use of medications should not be delayed, it is also recommended to practice non-pharmacologic pain measures.
Advise the patient to continue or to take medications as prescribed.Certain medications are used for the prevention of migraines. Proper timing in administering these medications help in decreasing the severity or altogether avoiding the migraine.
During migraine attacks, provide a non-stimulating environment.Bright lights and loud sounds may exacerbate the patient’s migraine.
Educate patients on the danger of taking medications that are not prescribed by the doctor.Some medications may trigger migraines and overuse of pain medications may cause medication-overuse headaches.
Advise patient to avoid fatigue and stress. Stress-reduction techniques may prove helpful.Regular sleep and relaxation may be helpful in avoiding headaches.
Apply symptomatic management such as antiemetics for vomiting and pain medications for pain.Management of present symptoms should reduce the negative experience of the patient.

Nursing Evaluation

InterventionRationale
Assess the patient’s willingness to follow lifestyle modifications.Consistency is the key to successful treatment outcomes. Diligently following the management plan is of vital importance to maintain the patient’s recovering state.
Assess for the severity of existing symptoms by using standardized scales.Any change in the intensity, frequency, and location of existing symptoms could imply an ongoing pathologic process that needs immediate attention.
Monitor the vital signs, pain status, and patient’s general well-being.To assess the response to treatment and monitor for side effects brought about by medications, procedures, and other interventions.
Assess the patient’s adherence to treatment and supportive management.Continuous compliance to treatment and management indicates good insight on the patient while poor compliance might need additional intervention.
Monitor for signs of medication-overuse headache.Continuous use of pain medications may cause a rebound effect.
Evaluate the patient’s knowledge on comfort measures during headache attacks.Independence promotion is essential in patientcare.
Evaluate if the patient will be able to strictly adhere to the medications prescribed by the physician.The patient should be able to independently self-administer his/her medications upon being discharged.

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. (2017). 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. (2018). 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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