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
|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
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.