Med-Surg - Nervous System, part 6: Migraine and Cluster Headaches
by Cathy Parkes October 29, 2021 Updated: August 09, 2023 3 min read
In this article, we cover migraine headaches vs. cluster headaches.
The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
A migraine headache is a neurovascular disorder that causes unilateral (on one side) throbbing head pain.
Migraines typically last 4-72 hours. For 15-30% of patients, that head pain may be preceded by an aura.
What is an aura in migraines?
An aura, as it pertains to migraines, is a visual or sensory disturbance. In the video, Cathy describes how she experienced a weird, flashing-light sensation over one of her eyes while she was driving! She got to school safely (but if this happens to you, pull over where it's safe). On the advice of her nursing school professor, Cathy acted proactively and took ibuprofen with a large coffee, which did help.
The pathophysiology behind migraine headaches is poorly understood. It's believed to be caused by activation of cranial nerve 5 and cerebral arterial vasodilation. Because of the vasodilation, the treatments discussed later in this article aim to cause vasoconstriction.
A family history of migraines is a risk factor for experiencing migraines. Also, women are more likely to experience migraine headaches than men.
Migraine triggers include bright/flashing lights, stress, anxiety, menstrual cycles, sleep deprivation, and certain foods. Foods containing MSG or tyramines can trigger migraines in some people.
Patients who have a migraine usually experience throbbing head pain, nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to noise), or an aura.
For a mild migraine, the treatment is usually NSAIDs like ibuprofen. If a patient has severe migraine, then medications like ergotamine and sumatriptan can be used. These medications' mode of actions are to cause vasoconstriction in the cerebral arteries. Caffeine can also be helpful, like in Cathy's story, because it is also a vasoconstrictor.
Antiemetics can be used for nausea and vomiting.
For patients with recurring migraines, prophylactic medications may be needed. This might include antihypertensives or anticonvulsants to help prevent the onset of migraines.
In terms of nursing care and patient teaching for migraines, you should instruct your patient to lay down in a dark, quiet environment if they are experiencing a migraine. This will help with the photophobia and phonophobia. They should also avoid triggers, so reducing their stress level if possible, and avoiding foods that may trigger a migraine.
A cluster headache is a neurovascular disorder that causes unilateral, non-throbbing head pain that typically lasts between 30 minutes and two hours. It typically happens at the same time of day for months and is more common in the spring and fall (rather than summer or winter).
The pathophysiology of cluster headaches is poorly understood, just like it is for migraine headaches. However, cluster headaches are thought to be caused by the sudden release of histamine or serotonin at cranial nerve 5, which is the trigeminal nerve.
The signs and symptoms of cluster headaches include severe, unilateral,non-throbbing head pain, and it typically happens around the orbital region. In addition to non-throbbing pain, the patient will also likely experience nasal congestion, facial sweating, a droopy eyelid, excess tearing in their eyes, agitation and pacing.
Ergotamine and sumatriptan, which are used to treat migraines, can also be effective at treating cluster headaches. There are other treatment options aimed at cluster headaches, which include oxygen therapy, corticosteroids, and verapamil, which is a calcium channel blocker.
Hi, I'm Cathy, with Level Up RN. In this video, I will be talking about migraine and cluster headaches. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video. So definitely, stay tuned for that. And if you have our Level Up RN Medical-Surgical Nursing flashcards, definitely pull those out so you can follow along with me.
First up, let's talk about migraines.
So a migraine headache is a neurovascular disorder that causes unilateral, meaning one side, throbbing head pain. And it typically lasts between 4 and 72 hours. For 15 to 30 percent of patients, that head pain may be preceded by what's called an aura.
So an aura is a visual or sensory disturbance.
So when I was in nursing school, I actually had a migraine headache for the first time. And as I was driving to school, I started getting this weird, flashing-light situation over one of my eyes. And it was kind of scary. So I got to school safely, luckily, talked to my nursing professor, and she's like, "You're about to get a migraine in all likelihood." And she recommended that I go get a large coffee and take some ibuprofen. So I did that, and I think it helped a lot. I ended up getting mild head pain, but I'm sure it would've been a lot more severe if I hadn't have acted proactively to drink that coffee and take the ibuprofen.
So in terms of the pathophysiology behind a migraine headache, it's actually poorly understood. But it's believed to be caused by activation of cranial nerve 5 and also cerebral arterial vasodilation. So because we have this vasodilation, the treatments we're going to talk about here, in a minute, for migraine headaches, are aimed at causing vasoconstriction.
So in terms of risk factors, a family history is definitely a risk factor. And women are more likely to get migraine headaches than men.
In terms of triggers, things that can trigger a migraine headache include bright or flashing lights as well as stress, which I definitely had in nursing school, and I'm sure you guys can relate. Anxiety is another trigger as well as menstrual cycles, sleep deprivation, and then certain foods. So foods that contain MSG or tyramines can sometimes cause or trigger a migraine headache.
In terms of symptoms, in addition to that unilateral, throbbing head pain, patients who have a migraine also typically experience nausea and vomiting as well as photophobia. So that's sensitivity to the light. They may also have phonophobia, which means sensitivity to noise. And then, like I mentioned, some amount of patients will have that aura before they end up having head pain.
In terms of treatment, for a mild migraine, NSAIDs can be used, such as ibuprofen.
If the patient has a severe migraine, then medications, such as ergotamine and sumatriptan, can be used.
And their mode of action is to cause vasoconstriction in those cerebral arteries. Caffeine is also helpful, just like what I took when I had a migraine headache, because that will also cause vasoconstriction.
Antiemetics can be used for that nausea and vomiting.
And then, for patients who have recurring migraine headaches, prophylactic medications may be warranted. So the provider may prescribe things, such as antihypertensives or anticonvulsants, to help prevent the onset of migraine headaches.
In terms of patient teaching, you should teach your patient to lay down in a dark, quiet environment when they are experiencing a migraine headache. So that will help with the photophobia and the phonophobia that come with a migraine headache. You also want to teach the patient to avoid triggers, so, if possible, reduce their stress levels and avoid foods that may trigger a migraine headache.
Next, let's talk about cluster headaches and talk about how they differ from migraines.
So a cluster headache is a neurovascular disorder that causes unilateral, non-throbbing head pain that typically lasts between 30 minutes and two hours. It typically happens at the same time of the day for months and is more common in the spring and fall versus the summer or winter.
In terms of the pathophysiology, it's actually poorly understood as we saw with migraine headaches. It is thought to be caused by the sudden release of histamine or serotonin at cranial nerve 5, which is the trigeminal nerve.
In terms of signs and symptoms, like I mentioned, it causes severe, unilateral, non-throbbing head pain, and it typically happens around the orbital region. So with migraine headaches, that was throbbing. With cluster headaches, that is non-throbbing. In addition to this non-throbbing pain, the patient will also likely experience nasal congestion, facial sweating. They may have a droopy eyelid, and it may cause excess tearing from their eyes. And then, in addition, agitation and pacing is common with patients who have cluster headaches.
In terms of treatment, ergotamine and sumatriptan, which we use to treat migraines, can also be effective at treating cluster headaches. However, there are some other treatment options that are specifically aimed at cluster headaches, which include oxygen therapy, corticosteroids, and verapamil, which is a type of calcium channel blocker.
Right. Time for a quiz. In this quiz, I'm going to give you a sign or symptom or trigger, and I want you to tell me if that is indicative of a migraine or cluster headache. All right. Number one, signs and symptoms include nausea and vomiting and photophobia. We're talking about a migraine headache here. Number two, pain is unilateral and non-throbbing. This is describing a cluster headache. Number three, signs and symptoms include facial sweating and excess tearing. All right. These are indicative, also, of a cluster headache. Number four, triggers include bright lights, stress, and menstrual cycles. And these triggers can cause a migraine headache.
All right. I hope this video has been helpful. Take care. And good luck with studying.
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