Mind/Body/Spirit

Could your headache really be a migraine?

At the headache clinic where I work, new patients typically tell me their headaches cause them to miss family events and limit leisure activities. But for many, the most common and pressing concern is that their headaches interfere with their work performance.Besides being painful, frequent bad headaches may reflect a more serious condition—migraine. Left untreated, migraines can be disruptive and even disabling. Most last several hours; some can span several days. About 29.5 million Americans suffer migraines, and more than half have never been diagnosed.
Frequent bad headaches—a frequent complaint among nurses
Many nurses experience frequent bad headaches that decrease their work productivity and cut into their leisure time and family life. An October 2006 survey of working adults found that nurses experience such headaches more often than other working adults, and their productivity suffers. The survey, which included 759 nurses and more than 1,400 working adults, revealed that among nurses who hadn’t been diagnosed with migraine, nearly 50% experienced frequent bad headaches, compared to 35% of other working adults. Of these nurses, 83% had never consulted a healthcare professional about their headaches.
Three in five of the nurses whose bad headache symptoms were consistent with migraine reported moderate to severe head pain, 44% cited sensitivity to light and sound, 37% experienced pain on one side of the head, and 14% reported seeing spots or flashes of light (a visual disturbance called an aura).
Migraine triggers
Stimuli that can trigger migraine include environmental conditions, such as extreme stress, irregular eating habits, and exposure to fluorescent or other bright light, as well as certain foods and beverages, such as cheese, chocolate, nuts, wine, and coffee. Many nurses in the survey said they regularly encounter these environmental triggers at work. About 70% reported an irregular eating schedule, 61% said they have long or irregular working hours, and more than half reported little to no exposure to natural light. In perhaps the most telling statistic, 43% experienced extreme stress on the job.
Approximately 40% of the surveyed nurses who’d experienced bad headaches or migraines said these symptoms decreased their job performance; more than one in five said their symptoms made them less productive. Nearly one in six nurses reported that bad headaches or migraines caused them to miss 1 hour or more of work per month.
When to suspect you might have migraine
According to the International Headache Society, the diagnosis of migraine applies when a person has had at least five attacks that fulfill these criteria (which can’t be attributed to another medical disorder):
• pain on one side of the head
• pain that’s moderate to severe
• pain that worsens with routine physical activity
• nausea or vomiting
• desire to avoid light and noise
• duration of 4 to 72 hours.
Taking the first step
Like many of my patients, some nurses don’t realize their headache symptoms could indicate migraine. If you have frequent bad headaches, don’t self-diagnose. Instead, consult your primary care provider for evaluation, diagnosis, and treatment.
Once diagnosed with migraine, you may be prescribed a drug to reduce the duration and intensity of the attacks. The most commonly prescribed migraine drugs are triptans, indicated for acute treatment. Experts recommend using triptans at the first sign of a headache.
If, despite using acute treatments, you experience recurring migraines that interfere with your normal routine, your healthcare professional may recommend prophylactic therapy. But know that although prophylactic drugs may significantly reduce migraine frequency, you may still need an acute migraine drug once an attack is underway.
Medications may not completely eliminate migraine in all patients, but they provide a great deal of control and can bring relief within a few hours, avoiding the need to suffer for up to several days. But drug therapy is just one component of a successful treatment regimen. Education in and awareness of migraine triggers are essential, too. By recognizing and avoiding common migraine triggers, you can significantly reduce the frequency of your attacks.
Getting back to work
When you suffer, your work productivity and effectiveness—including your ability to provide high-quality patient care—are likely to suffer, too. Before you can help others, you need to help yourself. Learn everything you can about migraines so you’ll be able to recognize symptoms in yourself as well as in your patients.
Most importantly, follow the advice of your primary care provider to minimize the misery of migraine. With proper diagnosis and treatment, you can get back to doing what you do best—providing expert patient care. O
Selected references
GlaxoSmithKline survey conducted online between October 2 and 23, 2006 among 759 U.S. nurses age 18 and over, of whom 317 reported frequent bad headaches.
GlaxoSmithKline survey conducted online between October 2 and 23, 2006 among 1,453 U.S. working adults age 18 and over, of whom 495 reported frequent bad headaches.
Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neurologies and facial pain. Cephalalgia. 2004;24:(supp 1).

For a complete list of selected references, visit www.AmericanNurseToday.com.Susan K. Baggaley, MS, APRN, is an Instructor at the University of Utah College of Nursing, a Nurse Practitioner at the College of Medicine at the University of Utah Department of Neurology, and co-director of the Headache Clinic at the University of Utah Health Sciences Center. She also has a full-time practice in which she sees patients with headache and facial pain. She lives and works in Salt Lake City.

Editorial assistance for this article was provided by GlaxoSmithKline. Headache Assessment Quiz and HeadacheQuiz.com are properties of GlaxoSmithKline. The headache survey described in the article was conducted online in the United States from October 2 to 23, 2006 by Harris Interactive® on behalf of the Institute for Health and Productivity Management and GlaxoSmithKline.



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