Migraines and Nursing: Awareness Is Key
By Debra Wood, RN, contributor
Many factors associated with a nursing job could contribute to a migraine attack in nurses genetically predisposed to the condition. Greater migraine awareness could help prevent some attacks and mitigate this troublesome disorder.
“People may be more prone to migraine attacks, because they are exposed to more triggers,” said Jill Dehlin, RN, CHES, a board member of the National Headache Foundation (NHF) and director of the NHF’s Patient Leadership Council. “The DNA is in us.”
Migraine often runs in families and, likely, multiple genes are involved, said A. Laine Green, MD, FRCPC, MSc, FAHS, a neurologist and headache-medicine specialist at the Dartmouth-Hitchcock Medical Center and an assistant professor at the Geisel School of Medicine, Dartmouth in Lebanon, New Hampshire, and a member of the American Migraine Foundation’s editorial board.
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About migraine disease
About 40 million Americans suffer from migraine disease, and it is a leading cause of disability, according to the National Headache Foundation. Many people do not know they have migraine.
“Migraine is a very real thing and under-diagnosed,” said Calli Cook, NP, DNP, APRN, FNP-C, at Emory Brain Center in Atlanta and an assistant professor at the Neil Hodgson Woodruff School of Nursing at Emory University.
“Getting to the correct diagnosis is key,” Green added. Many primary care professionals treat migraine, but referral to a headache specialist can benefit patients who have not received relief after trying several treatments or are having side effects as a barrier to treatment.
In addition to headache, migraine can present with nausea, vomiting, fatigue, brain fog and vision changes. Some patients experience an aura.
June is National Migraine & Headache Awareness Month, calling attention to the condition and increasing migraine awareness and prevention strategies and treatments.
“There is a stigma associated with migraine,” said Dehlin, adding that to fight stigma, people with migraine disease should talk about it and advocate for themselves. Raising migraine awareness also can help.
Nurses and migraines—Is there a connection?
Little evidence exists connecting a U.S. nursing job with migraine attacks, however, a couple of studies in India and Taiwan reported higher risk of migraine attacks in nursing students and healthcare workers, citing stress, sleep disturbances and missed meals, which are common migraine triggers.
The connection between nurses and migraines may be due to nursing being a female-dominated profession, and migraine attacks are more common in women, Green reported.
The Society for Women's Health Research reports that three out of every four people with migraines are women, who also have longer migraine episodes and more migraine-related symptoms.
Some women experience hormonal or menstrual migraine attacks, Cook said.
Nursing jobs are stressful, and stress is a big trigger, Green indicated.
This past year may have been especially difficult for affected nurses and other people with migraine disease. A fall 2020 survey by Headache and Migraine Policy Forum and Migraine Again found among people with migraines, 69 percent had a monthly increase in attacks during the pandemic.
Additionally, nurses frequently do not sleep enough nor consume regular meals. Many skip eating during a busy shift. Fluorescent lighting, loud noises, changes in barometric pressure and fragrances also can act as triggers.
However, spontaneous migraine attacks are common, and migraine in not always due to triggers, Green said. A migraine can occur when a certain threshold is reached.
Managing migraine requires a multifaceted and comprehensive approach, with consistency in daily routines, including a regular sleep schedule, meals, aerobic activity and hydration, Green said.
Dehlin recommended keeping a diary, tracking triggers and migraine attacks to note any associations. Document medication used. Then take the information to a healthcare provider.
Lifestyle modifications can make a difference in preventing migraine attacks, and preventive medications are available.
“I tell all of my patients, you need seven hours of sleep,” Cook said. “That’s especially difficult for nurses who do shift work.”
Patients with migraine disease should avoid caffeine, Green said.
Deli meats, hot dogs, fermented cheeses, draft beers, yeast bread, peanuts and peanut butter, and chocolate can trigger a migraine in some patients, Cook said.
Migraine glasses can block the fluorescent lighting, protein bars can help if someone must skip a meal, and WeatherX earplugs can tame changes in barometric pressure, Dehlin said.
Aerobic exercise, yoga, meditation and related apps, paced breathing and cognitive behavioral therapy to understand the pain response can all prove beneficial in preventing migraine attacks.
Medications taken as a reduction strategy are available. Green advised talking with a healthcare provider about preventive treatments if someone has four or more headache days per month or a high amount of disability.
“The longer you wait to get treatment, the greater your chances of going from episodic to chronic migraine attacks,” Dehlin said. “No one should suffer from uncontrolled migraine. There are treatments, and there is hope.”
Multiple treatment options exist, including medications and supplements, such as riboflavin and magnesium, Cook said.
Some patients might obtain relief with a nonsteroidal anti-inflammatory drug, such as naproxen or ibuprofen. However, taking such drugs more than 10 days per month can lead to medication-overuse headaches, Green said.
“You can actually cause a vicious cycle of more headache,” Dehlin cautioned.
Every patient regardless of their migraine frequency needs an acute therapy, said Cook.
Options include triptans, ergot alkaloids, calcitonin gene-related peptide inhibitors and onabotulinumtoxinA, the last reserved for people with 15 or more headache days.
"It’s good to have different options in the toolbox,” Green said.
In addition, the person with a migraine should rest in in a dark, quiet room with a cool cloth on the forehead, but that’s not going to happen if a nurse is working with patients.
Relaxation techniques and biofeedback can be helpful when the pain starts, Cook said.
Cook encouraged people suffering with headaches or migraine to talk with their healthcare provider. Many options from lifestyle changes to medications to devices exist.
“You don’t have to live like that,” Cook said. “Work with a healthcare provider to meet your needs and allow you to live life the way you want to live it.”
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