MIGRAINE HEADACHES
Barbara is a 35-year-old black female who comes to the emergencydepartment (ED) with a severe headache that has lasted over 4 days.At triage, Barbara appears to be in acute distress. Unable to finda comfortable position, she is holding her head in her hands whilerocking back and forth. Barbara’s vital signs on arrival aretemperature 98.6° F, pulse 90. respirations 28. and blood pressure(BP) 214/129. Barbara describes paresthesia on the right side ofher body with some tingling and weakness in the right hand. She hasa right facial droop. Barbara also complains of having had nauseaand vomiting for this same 4-day period.
Triage Assessment, Acuity Level IV: Appears in acute distress,describes “worst headache. ” BP diastolic >l 15, andneurological deficits.
Barbara is brought immediately to the treatment area where shedescribes visual changes with streaking, flashing lines that beganwith the onset of her headache. Barbara states that her menses justfinished prior to the onset of this attack, a usual precursor forher headache. Barbara also shares that she has been feeling”depressed” since she separated from her husband 2 months ago.Barbara’s past medical history includes diagnosed migraineheadaches with almost monthly visits to the ED. Hypertension anddepression are also chronic problems for her.
Barbara’s current medications include hydrochlorothiazide (HCTZ),verapamil, nortriptyline, Reglan, Phenergan, and Demerol. She isallergic to Compazine (seizures), Stadoi and Thorazine (syncope),Inderal (rash), codeine and Dilaudid (nausea). Barbara’s physicalassessment is normal except for the described neurologicaldysfunctions.
Barbara is placed in a room that is darkened and away from the mainflow of activity. She is started on an intravenous solution ofnormal saline at 250 ml/hr. While in the ED. Barbara receives atotal of 450 mg of meperidine with 150 mg of Vistaril, all givenintramuscularly, before any relief of her headache and symptoms isobtained. When Barbara is released from the ED. no prescriptionsare given to her and she is instructed to have a follow-up with herprivate neurologist.
QUESTIONS AND ANSWERS
1. What are migraine headaches?
2. How is the diagnosis of migraine headache achieved?
3. What nursing diagnoses should be considered in this patientpresentation?
4. What are the medical and nursing care measures for the patientwith a migraine headache?
