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Managing Migraine and Headaches as a Nurse Practitioner

Migraine and Headache Awareness Month

Help your patients prevent and treat migraine attacks in order to improve their quality of life.

According to the World Health Organization (WHO), “Globally, headache disorders affect approximately 40% of the population, or 3.1 billion people in 2021, and are more common in females compared to males.” Across the world, headaches “are among the top three most common neurological conditions for most age groups, starting with age 5 and remaining in the top three until the age of 80.”

Beyond painful, these headaches are disabling for patients living with them. The Global Burden of Disease study 2019 (GBD2019) named migraine as second among the world’s causes of disability, and first among young women. The authors of the GBD2019 report went on to add, “While there is no cure for these disorders, there are effective symptomatic and preventive treatments available.” June is National Migraine and Headache Awareness Month, a time for nurse practitioners (NPs) to raise awareness of these disorders, dispel common myths and discuss the latest treatments available to patients with migraine attacks and headaches.

Differentiating Headache Disorders

While everyone experiences headaches in one form or another, patients may not realize they have a headache disorder that requires medical screening and treatment. In an article for the Journal for Nurse Practitioners (JNP) entitled “Headache as a Diagnostic Dilemma,” author Barbara Bishop, MS, ANP-C, CNRN, MSCN, states that, “Headache is one of the most common medical disorders in health care. Its prevalence in the population is 17.6% for women and 6% for men, yet accurate diagnosis remains a constant challenge.”

To this end, Bishop defines patients with primary headache disorders as having “headaches that are episodic but occur repeatedly over time, so it is thought of as a chronic syndrome. The headaches often interfere to some level with activity, whether suboptimal performance at work, missing a planned activity or being totally incapacitated for the day or days. The headaches may also be described as pain, pressure, pounding or throbbing, or tightness.” WHO lists the four common types of headache disorders as:

  1. Migraine is a primary headache disorder that is often accompanied by nausea, vomiting, photophobia and phonophobia.
  2. Tension-type headaches are marked by pressure or tightness, often like a band around the head, sometimes spreading into or from the neck. They may be stress-related or associated with musculoskeletal problems in the neck.
  3. Cluster headaches are characterized by frequently recurring (up to several times a day), brief but extremely severe headaches, usually focused in or around one eye, with tearing and redness of the eye. The nose often runs or is blocked on the affected side and the eyelid may droop.
  4. Medication-overuse headaches are caused by chronic and excessive use of medication to treat headaches and are the most common secondary headache disorder.

The American Association of Nurse Practitioners® (AANP) is here to support NPs in helping diagnose and treat these headache disorders. If you are looking for handy “dos and don’ts” for providers, as well as pharmacological and non-pharmacologic interventions based on evidence, review the Guideline for Primary Care Management of Headaches in Adults on the AANP website. These guidelines provide recommendations on counseling, diagnosis, evaluation, management, prevention and treatment for primary headache disorders.

Understanding and Managing Migraine

Migraine takes center stage in National Migraine and Headache Awareness Month above other headache disorders — and with good reason. According to the American Headache Society, more than 37 million Americans are living with migraine attacks. In an article for We Choose NPs entitled “Migraine Insights: Understanding Triggers, Symptoms and Effective Treatments,” Monica Hauger, FNP, describes migraine as “headaches that, untreated, last between 4 to 72 hours. They are often described as a throbbing headache on one side of your head, but can also be on both sides. These types of headaches are moderate to severe in intensity, and — in addition to the pain — come with at least one other symptom such as light sensitivity, sound sensitivity, nausea or vomiting.”

Although these symptoms are common, Hauger states that “Not everyone who suffers with migraines will experience the same symptoms.” In fact, some people may experience the onset of a migraine attack days in advance (known as a migraine with aura), while others will receive a headache without warning (known as a common migraine). Regardless of what kind of migraine patients are experiencing, it is helpful to note that migraine attacks are typically broken down into four phases:

  1. Prodrome is the first phase of a migraine attack and can last for hours to days.” Patients in this stage may experience food cravings, unexplained mood changes, uncontrollable yawning, fluid retention or increased urination.
  2. Aura is the second phase of a migraine and “can present as changes in smell or state, flashing lights or a funny feeling.” These funny feelings can include muscle weakness or the sensation of being touched or grabbed.
  3. Headache is the third phase of a migraine attack and can last up to three days if untreated. It is marked by a strong, throbbing pain on one side of the head, but patients may also report nausea, inability to sleep, anxiety and sensitivity to sound, light and smell.
  4. Postdrome is the final phase of a migraine attack. Patients typically experience fatigue, mood changes and difficulty concentrating for about a day until this period ends.

“Although there is not a cure, there are many treatments for migraines,” states Hauger. “Treatments are classified as acute and preventative.” Conveniently, AANP has developed various guidelines for the acute and preventive treatment of migraine in children and adolescents. These guidelines outline more than a dozen recommendations for practitioners, including both pharmacologic and nonpharmacologic interventions based on evidence. Additionally, patients of all ages should be mindful of what triggers their migraine and consult their providers on appropriate lifestyle changes they can make based on those triggers. Providers should encourage patients to take up a headache diary to start recording symptoms of their migraine and take that data back to their next appointment. Through careful observation, preventive care and treatment options, NPs can improve patients’ quality of life. As Hauger tells patients, “Start the conversation about migraine with your NP or other health care provider because treatment is out there, and it can make all the difference.”

Continue Your Neurology Journey in the AANP Communities

If you’re interested in migraine attacks and other topics of the brain, spinal cord, nerves or muscles, AANP has a place for you. The Neurology AANP Community offers a unique opportunity to interactively collaborate with colleagues who share interest or clinical expertise in neurology.

As an AANP Community member, you’ll have access to a cutting-edge, online forum where you can engage in discussions, document sharing and knowledge exchange with your fellow NPs. Come learn, share and help progress the development of theory and practice in neurology.

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