Migraine & Headache Nursing Care

Primary headaches are disorders in themselves — migraine (throbbing, unilateral, with nausea and light/sound sensitivity), tension-type (bilateral, band-like, pressing), and cluster (severe, unilateral, around the eye, with tearing and nasal congestion, in clusters). Secondary headaches are symptoms of another problem — subarachnoid hemorrhage, meningitis, tumor, temporal arteritis — and can be life-threatening. Screening for red flags comes first.

Characterize the headache (OPQRST): location, quality (throbbing vs band vs stabbing), severity, timing, triggers, and associated features (nausea, photophobia, aura, tearing/congestion). Distinguish the patient’s usual headache from a new or different one. Screen for the SNOOP red flags and do a focused neuro exam. A sudden “worst headache of my life,” fever with neck stiffness, or new focal deficits demands emergent evaluation.

Chronic headache is often dismissed, leaving patients frustrated and undertreated. Validate the disability migraines cause, take the pain seriously, and partner on a plan rather than implying it’s “just stress.” Explore the impact on work and life, and coach realistic trigger and lifestyle changes. Be alert that a patient minimizing a truly different headache may be downplaying an emergency.

Teach taking abortive medication at the first sign of an attack, the limit on acute-medication days to avoid rebound headache, and adherence to preventives. Review trigger identification and a headache diary, sleep/meal regularity, and stress management. Stress that women with migraine WITH aura should avoid estrogen-containing contraceptives (stroke risk), and teach the warning signs (sudden severe headache, fever/stiff neck, weakness, vision/speech changes) that mean seek emergency care.