Migraine Headache Health Article

Health care team roles

The advanced practice nurse (APN) can play a pivotal role in helping patients control migraine symptoms. One of the most important screening questions for a patient with a headache is "Do you think that this is the worst headache you have ever had?" If the answer is yes, a more thorough diagnostic work up is justified in order to rule out any tumor or brain bleed. Imaging studies, like CT and/or MRI scanning, which are performed by a radiologist technician, should be considered.

The APN must recognize that many people with migraines are underdiagnosed and unhappy with the practitioner's treatment plan. Knowing this will help the APN focus on both quick pain relief methods and complementary therapies.

The registered nurse (RN) and licensed practical nurse (LPN) can also contribute to a patient's successful migraine management by reinforcing the concept of rapid medication administration at the initial onset of migraine symptoms.

Patient education

The importance of teaching patients about their migraine medications and any potential side effects cannot be overstated. Explaining the expected time frame for relief before administering the next medication is helpful. Nurses can also advise patients about nonpharmacological interventions that may also be beneficial for migraine sufferers. Finally, the RN or LPN can demonstrate breathing relaxation techniques for patient to reinforce their proper use and understanding.

Prevention

The frequency of migraine may be lessened by avoiding triggers. It is useful to keep a headache journal, recording the particulars and noting possible triggers for each attack. Specific measures which may help include:

• eating at regular times, and not skipping meals
• reducing the use of caffeine and pain relievers
• restricting physical exertion, especially on hot days
• keeping regular sleep hours, but not oversleeping
• managing time to avoid stress at work and home

Some drugs can be used for migraine prevention, including specific members of these drug classes:

• beta blockers
• tricyclicantidepressants
• calcium channel blockers
• anticonvulsants
• fluoxetine (Prozac)
• monoamine oxidase inhibitors (MAOIs)
• serotonin antagonists

For most patients, preventive drug therapy is not an appropriate option, since it requires continued use of powerful drugs. However, for women whose migraines coincide with their menstrual periods, limited preventive treatment may be effective. Since these drugs are appropriate for patients with other medical conditions, the decision to prescribe them for migraine may be influenced by expected benefit elsewhere.

KEY TERMS

Migraine—A type of headache marked by severe head pain lasting several hours or more.

Neuropeptide—A peptide (chemical derived from protein) that affects nerves and their functions. Endorphins and enkephalins are neuropeptides.

Neurotransmitter—Chemical produced by nerve cells that sends an impulse across a synapse to a muscle, organ, or another nerve cell. Norepinephrine and acetylcholine are types of neurotransmitters.

Nociceptors—Nerve cells in the brain that are responsible for the sensation of pain.

Photophobia—Sensitivity to light.

Phonophobia—Sensitivity to sound.

PERIODICALS

Clinch, C. Randall. "Evaluation of Acute Headaches in Adults." American Family Physician 63 (February, 2001): 685—692.

Kunkel, Robert. "Managing Primary Headache Syndromes." Patient Care 34 (January, 2000): 100 ff.

Lipton, Richard B. "Sumatriptan for the Range of Headaches in Migraine Sufferers: Results of the Spectrum Study." Headache 40 (2000): 783—791.

Scholz, Mary. "Treatment Options for Acute Migraine." RN 63 (October, 2000): 99.

OTHER

American Medical Association. Journal of the American Medical Association: Migraine Information Center. <http://www.ama-assn.org/special/migraine/>.

Matchar, David B., Douglas C. McCrory, and Rebecca N. Gray. "Toward Evidence-Based Management of Migraines." <http://jama.amaassn.org/issues/v284n20/ffull/jed00081.html>. (April 27, 2001).

Lori Beck