1. General information
    1. Diffuse pain in different parts of the head
    2. Types
      1. Functional
        1. tension (muscle contraction): associated with tension or anxiety
        2. migraine: recurrent throbbing headache
          1. often starts in adolescence
          2. affects women more than men
          3. vascular origin: vasoconstriction or spasm of cerebral blood vessels (producing an aura) then vasodilation
        3. cluster: similar to migraine (vascular origin); recur several times a day over a period of weeks followed by remission lasting for weeks or months
      2. Organic: secondary to intracranial or systemic disease (e.g., brain tumor, sinus disease)
  2. Assessment findings
    1. Tension headache: pain usually bilateral, often occurring in the back of the neck and extending diffusely over top of head
    2. Migraine headache: severe, throbbing pain, often in temporal or supraorbital area, lasting several hours to days; may be an aura (e.g., visual disturbance) preceding the pain; nausea and vomiting; pallor; sweating; irritability
    3. Cluster headache: intense, throbbing pain, usually affecting only one side of face and head; abrupt onset, lasts 30-90 minutes; eye and nose water on side of pain; skin reddens
    4. Diagnostic tests may be used to rule out organic causes.
  3. Nursing interventions
    1. Carefully assess details regarding the headache.
    2. Provide quiet, dark environment.
    3. Administer medications as ordered.
      1. Symptomatic during acute attack
        1. nonnarcotic analgesics (aspirin, acetaminophen [Tylenol])
        2. Fiorinal (analgesic-sedative/ tranquilizer combination)
        3. for migraines, ergotamine tartrate (Gynergen) or ergotamine with caffeine (Cafergot); vasoconstrictors given during aura may prevent the headache
        4. Midrin (vasoconstrictor and sedative)
        5. Sumatriptan (Imitrex) causes vasoconstriction in cerebral arteries; given via cutaneous injection.
      2. Prophylactic to prevent migraine attacks
        1. methysergide maleate (Sansert): after 6 months' use, drug should be discontinued for a 2-month period before resuming
        2. propranolol (Inderal) and amytriptyline (Elavil): have also been used in migraine prevention
    4. Provide additional nursing interventions for pain (see General Nursing Interventions).
    5. Provide client teaching and discharge planning concerning
      1. Identification of factors including diet that appear to precipitate attacks
      2. Examination of life-style, identification of stressors, and development of more positive coping behaviors
      3. Importance of daily exercise and relaxation periods
      4. Relaxation techniques
      5. Use and side effects of prescribed medications
      6. Alternative ways of handling the pain of headache: meditation, relaxation, self-hypnosis, yoga.