Key Assessment Questions Related to Headache

• Is this the patient’s first headache?
• When did this headache start?
• Has the patient been injured recently?
• Have there been any personality changes?
• Has the patient experienced any memory loss?
• Has the patient had a recent infection?
• Does the patient have any problems with vision?
• Has the patient had any recent neurologic problems?
• Does the patient have hypertension? For how long?
• Does the patient have any emotional problems?
• What medication is the patient currently taking?
• Has the patient ever had a seizure?

Source: Sheehy’s Emergency Nursing: Principles and Practice, 4th Edition. Lorene Newberry, ed. St. Louis, Missouri: Mosby-Year Book, Inc.;1998.

Types of Vascular Migraine Headaches

Type Description
Classic migraine Aura that lasts 15-20 min; clears more quickly than it develops; severe pain, usually unilateral, can be bilateral; lasts 30 min to several days; photophobia, sound sensitivity, nausea, vomiting, and anorexia; worsened by walking, straining, or sudden changes in body position; occurs during increased stress and pregnancy. 
Treatment includes ergotamines, sumatriptan (Imitrex) 
 
Common migraine Euphoria, hunger, depression, irritability, intense yawning, generalized edema, and photophobia present; usually does not occur during pregnancy. 
Treatment includes ergotamines, sumatriptan 
 
Cluster headache Ten times more common in men; closely grouped attacks over several weeks followed by remission of months or years; may have 12 or more headaches per day; more frequent in spring and fall; excruciating, unilateral pain, usually behind eye or in temporal region; may travel to ear, nose, and cheek; facial flushing, nasal congestion, lacrimation, rhinorrhea, and salivation may be present; may wake patient from deep sleep or occur during periods of rest after exhaustion. 
Treatment includes oxygen, ergotamines, sumatriptan, prednisone, and, in some cases, lithium 
 
Opthalmoplegic migraine Begin during infancy or early childhood; headache and paralysis of cranial nerve III; if untreated, prominent visual field defects or blindness may occur. 
Treatment includes ergotamines, sumatriptan, and steroids
 
Hemiplegic migraine Visual field defects, numbness of mouth and/or extremities, and various paresthesias; unilateral extremity weakness or paralysis; family history positive for migraine. 
Treatment includes rest, sedation, analgesia, and increasing CO2 levels; ergotamines contraindicated 
 
Facial migraine Unilateral episodic facial pain; associated with cluster headache or common migraine 
 
Migraine equivalent All features of migraine present except headache; symptoms include vomiting, abdominal migraines, menstrual syndromes, precordialmigraines, and periodic diarrhea, fever, mood changes, and sleep or trancelike states
 
Source: Sheehy’s Emergency Nursing: Principles and Practice, 4th Edition. Lorene Newberry, Ed. St. Louis, Missouri: Mosby-Year Book, Inc.; 1998.