MWAMI SCHOOLS OF NURSING AND MIDWIFERY

TOPIC: MIGRAINE HEADACHE

BY: BALDWIN HAMOONGA

5TH YEAR NURSING STUDENT (RU)

SUPERVISOR: MR.J. NYIRENDA

 GENERAL OBJECTIVES

• By the end of this lesson 2nd year RN nursing students should be able to
demonstrate an understanding on migraine headache and be able to
manage a patient with it.

SPECIFIC OBJECTIVES

By the end of this lesson, 2nd year RN nursing students should be able to;

• Define migraine headache

• List the migraine triggers

SPECIFIC OBJECTIVES CONT’

• Explain the phases of migraine headache

• Mention the classification of migraine headache

• Discuss the management of migraine headache

• Explain the complications of migraine headache

DEFINITION

Migraine headache is a familial disorder characterized by recurrent

attacks of headache widely variable in intensity, frequency and duration
(George D et al, 2018). Attacks are commonly unilateral and are usually
associated with anorexia, nausea and vomiting.
MIGRAINE TRIGGERS

• Disturbed sleep pattern

• Hormonal changes

• Drugs e.g. weed, caffeine etc.

• Physical exertion

• Visual stimuli

• Auditory stimuli
MIGRAINE TRIGGERS CONT’

• Olfactory stimuli

• Weather changes

• Hunger

• Psychological factors
PHASES OF MIGRAINE HEADACHE

• PRODROME

• AURA

• HEADACHE

• POSTDROME
PHASES OF MIGRAINE HEADACHE

PRODROME
• Vague premonitory symptoms that begins from 12-36 hours before the
aura and headache.
Symptoms:
• Yawning
• Excitation
• Depression
• Lethargy
• Craving or distaste for various foods
Duration: 15-20 minutes.
PHASES OF MIGRAINE HEADACHE CONT’
AURA
• Aura is a warning or signal before onset of headache.
• Symptoms:
• Flashing of lights
• Zig-zag lines
• Difficulties in focusing
• Duration: 15-30 minutes
PHASES OF MIGRAINE HEADACHE CONT’
• HEADACHE
• Headache is generally unilateral and is associated with the following
symptoms:
• Anorexia
• Nausea
• Vomiting
• Photophobia
• Phono phobia
• Tinnitus
• Duration: 4-74 hours.
PHASES OF MIGRAINE HEADACHE CONT’
POSTDROME
Following the headache, patient complains of;
• Fatigue
• Depression
• Severe exhaustion
• Some patients feel unusually fresh
• Duration: few hours or up to 2 days .
CLASSIFICATION

According to headache classification committee of the international

headaches society, migraine has been classified as:

• Migraine without aura

• Migraine with aura

• Complicated migraine
MANAGEMENT
GOALS

• Establish diagnosis • Establish reasonable

• Educate patient expectations
• Discuss findings • Involve patient in decision
• Choose the best treatment • Encourage patient to avoid
• Create treatment plan triggers
MANAGEMENT

LONG TERM TREATMENT GOALS

• Reducing the attack frequency and severity

• Avoiding escalation of headache medication.

• Educating and enabling the patient to manage the disorder.

• Improving the patient’s quality of life.

MANAGEMENT

DIAGNOSIS
Medical history
• Use of personal and family history of migraine headache can help to
diagnose migraine.
Headache diary
• check the record of headache attacks by asking the patient when, how
and where the pain originate / feels it from.
Migraine triggers
Ask the patient some of the things that lead to the headache e.g., food.
MANAGEMENT

INVESTIGATIONS

Electroencephalography (EEG)

• Monitors electrical impulses activities of the brain.

Computed tomography (CT)

• Brain scan-create images-tumors, sinus blockage, bleeding.

Magnetic resonance imaging (MRI)

• high images, tumors, bleeding, blockages.

PHARMACOTHERAPY

ABORTIVE THERAPY

PREVENTIVE THERAPY

ABORTIVE THERAPY

Non-specific therapy

Aspirin

• Dose: 500-1g q4hrly orally not to exceed 4g per day.

• Side effect: Nausea, stomach pain, tinnitus.

PHARMACOTHERAPY CONT’

Acetaminophen

• Dose: 500-1000 mg not to exceed 4g per day.

• Side effect: bloody or black stool. Tarry stool, skin rash.

Ibuprofen

• Dose: 200-400 mg q6hrly not to exceed 4 grams.

• Side effects: upset stomach, vomiting, bloating, dizziness and

headache.
PHARMACOTHERAPY CONT’

Diclofenac

• Dose: 50-100 mg tds

• Side effects: headache, diarrhea, itching

Naproxen

• Dose:500-500 mg PO not to exceed 1250 Mg in 24 hours.

• Side effects: increasing sweating, diarrhea, increasing blood pressure.

PHARMACOTHERAPY CONT’
SPECIFIC TREATMENT
ERGOT ALKALOIDS( anti-dopamine, vasoconstrictors)
Ergotamine
• Dose: 1-2 mg/d maximum 6 grams / day orally.
• Side effects : weakness, hypertension, muscle pain, impaired speech.
Dihydroergotamine
• Dose: 0.75-1 mg IV/IM/SC q1hr PRN not to exceed 2mg IV or 4mg
IM/SC per 24 hours’ period.
• Side effects: fast or slow heart rate, chest pain, nausea , sudden
headache.
PHARMACOTHERAPY CONT’
5-HT RECEPTOR AGONISTS( anti-serotonin(serotonin influence
biological and neurological process e.g. anxiety, aggression, mod,
memory, nausea, learning, sleep & thermoregulation)
Sumatriptain
• Dose:25-200 mg q2hrly orally. Not to exceed 200mg per day. 6 mg SC
not to exceed 12 mg/day.
• Side effects: numbness, pricking/heat, weakness, drowsiness or
dizziness.
PHARMACOTHERAPY CONT’

Rizatriptan
• 5-10 mg orally 2 hourly, not to exceed 30mg/day
• Side effects: numbness, pricking/heat, weakness, drowsiness or
dizziness.
PHARMACOTHERAPY CONT’

PREVETIVE THERAPY
BETABLOCKERS( block epinephrine(adrenaline) hormone)
Propranolol
• Dose: 80 mg/day PO divided q6-8hr initially may be increased by 20-
40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided
q6-8 hours, withdraw therapy if no desired response seen after 6
weeks.
• Side effects: bradycardia, hypotension, depression, insomnia and
fatigue.
PHARMACOTHERAPY CONT’
CALCIUM CHANNEL BLOCKERS
Flunarizine
• 5-10 mg/day at bed time PO.
• Contraindication: pregnancy, lactation.
• Side effects: drowsiness, dry mouth, insomnia, gastric pain.
PHARMACOTHERAPY CONT’

TRICYCLIC ANTIDEPPRESANTS(TCA)-prevent retake of serotonin

& norepinephrine(neurotransmitters).

Amitriptyline

• Dose: 10-25 mg PO qhs; 10-400mg PO qhs dose range.

• Side effects: agitation, alopecia, anxiety, anorexia, ataxia, confusion,

blurred vision, diarrhea and constipation.
PHARMACOTHERAPY CONT’
SELECTIVE SEROTONIN RE-UPTAKE INHIBITORS(SSRIs)
Fluoxetine
• Dose: 20-40 mg PO qDay
• Side effects: insomnia, nausea, headache, weakness and diarrhea
NURSING MANAGEMENT

psychological care

• nurses should collect disease history identify the triggers (foods, drinks,
perfumes, noise) educate and encourage the patient to avoid triggers that
may lead to the headache.

Reduce stressing activities

• Meditation

• Relaxation training e.g. Yoga 

NURSING MANAGEMENT CONT’
Develop good sleep habits

• Interrupted sleeping pattern may lead to headache and mode changes.

• Encourage the patient to be having good sleep.

Take medications as prescribed

• Patients should be educated on uptake Medications by the nurses,

drugs must not be overdosed just because of severe pain as they can
produce severe side effects.
COMPLICATIONS

STATUS MIGRANOSUS

• This is rare and severe migraine with aura lasts for longer than 72
hours, a person can be hospitalized due to the intense of the pain.

MIGRANOUS INFARCTION

• This is when a migraine is associated with stroke, this is a migraine

headache with aura that lasts more than an hour.
COMPLICATIONS CONT’

• The aura at times can be present even when the headache disappears,
an aura that lasts longer than an hour is a sign of bleeding in the brain.

MIGRALEPSY

• This is a condition where an epileptic seizure is triggered by a

migraine, usually the seizure may occur within an hour after a
migraine, it’s a rare condition.
COMPLICATIONS CONT’
STROKE

• A stroke occurs when blood supply to the brain is cut off or blocked
by a blood clot or fatty material in the arteries. People with migraine
have about twice the risk of having stroke, and women with migraine
who take contraceptives also have a greater risk of stroke, the reason is
not fully understood.
SUMMARY

• We have discussed migraine as a unilateral recurrent headache which

is in three phases namely; prodromal, aura, headache and postdrome,
we have discussed what happens under each phase. We have also
looked at the triggers of migraine to mention a few are; psychological
factors, weather, drugs and olfactory factors.
SUMMARY CONT’

• We have also looked at the management in which we said there are

three managements; non-specific, specific and preventive, under these
managements we have discussed drugs used. We have also discussed
about the possible complications of migraine headache such as; stroke,
migranous infarction, and migralepsy.
REFERENCES

• Headache classification committee; the international classification of

headache disorders. 2nd edition. Cephalagia.2004; 24:1-160

• Lipton RB, Bigal ME, Diamond et al (2007); migraine prevalence,

disease burden and the need for preventive therapy, neurology.

• Radat F, Swendsen J (2004). psychiatric comorbidity in migraine: a

review, Cephalagia.

• George D, Michele R, Mindy H et al (2018): Medscape journal of

medicine; Medgenmed.