Managing a Migraine

Migraines can be brutal. Having a plan to combat them can be a lifesaver, for you and your patients. Here are tips for working with a migraine.

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Managing a Migraine

The ding...ding...ding...ding of call bells.

The flash...flash...flash...flash of call lights.

The smells. Doesn't matter if they are good or bad. Why do they seem so much stronger when you have a migraine? And...cue the nausea.

The need to comprehend in-depth medical...things. And then, you are expected to respond to these things with some level of intelligence and competency.

Are these people even speaking English?

Start an IV? You're not even sure your hands and your brain are still properly connected.

And, Heaven forbid a code should happen! The alarms...so many things happening all at once...was the doctor talking to you just then? What were you supposed to be doing, anyway? Is this my patient? Because you don't know anything about them if they are!

Working in the medical field while suffering from a migraine attack can be...tricky, to say the least.

Sometimes calling out sick or going home early with a migraine just isn't an option. You've taken all the medication you can, whether you were able to keep them down or not. It still hurts. You still can't focus. You need to eat, but will it stay down? What do you do now?

Migraines are different for everyone who experiences them. And they can be very unpredictable. Between the pain, nausea, vertigo, aphasia, the fill-in-the-blank symptoms; how do you cope with that during a busy shift?

It's not like you can go lie down in a dark room until it passes. You must keep functioning, and functioning at a very high level.

Everyone you talk to has a sure-fire way to cure migraines, whether they have ever had one or not. Let's be honest, most of them don't work. Or at least don't work as well as you'd hoped they would. And most of them won't work while you are busting your tail on a busy hospital unit.

However, there are several things you can try while at work:

Let your coworkers know what is going on

Most of the time your coworkers will be willing to help you, or at least give you some grace if you explain the situation to them. This is especially important if you have aphasia with your migraines! Whether it is receptive or expressive aphasia (or both!), explaining your condition to coworkers is always the best thing to do. At least they now know why you are acting like a drunk idiot.

Suck on a peppermint

Some brands of peppermints contain real peppermint oil and may relieve at least a bit of the pain and nausea. And it tastes good and helps your breath! Can't hurt.

Stimulate the olfactory nerves

Try sniffing some peppermint or ginger essential oil. Sometimes this can help relieve the pain and nausea, maybe even clear your head a bit.

Try an ice pack

This one is a bit difficult to finagle. You can't exactly walk around answering call lights and starting IVs while holding an ice pack to your head. But charting is a different story altogether; placing an ice pack on your temple or the back of your neck while charting can often bring a bit of relief, at least while you are sitting there.

Take a quick break

Not always an option on busy shifts, but if you can take just a short break in a quiet (emphasis on the word quiet) room, it might be just the thing to help pull you through the rest of your shift.

Eat something

Again, this is not always an option due to nausea and/or time constraints, but getting something into your stomach will often help both the pain and nausea.

Chart after report

Between the pain and the constant interruptions and the inability to focus, your charting can become a big mess if you try to chart during your shift. Waiting until report is over and you can sit down and focus just on charting is sometimes the best option. Sometimes it's the only option. Better to stay late than to make a mistake in your charting.

Your Tips

Migraines can be brutal. Having a plan to combat them can be a lifesaver, for you and your patients.

Do you have any tips to add to the list?

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Kristi Van Winkle

About Kristi Van Winkle, BSN, RN

Kristi Van Winkle has 17 years experience as a BSN, RN and specializes in Pediatrics/Telemetry/Health and Wellness.

4 Articles   16 Posts

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Specializes in Critical Care.

I lived with frequent migraines from my teens until I retired.  Now I've only had a couple bad ones in the last year which is a major improvement.  I think because I'm no longer under the intense stress.  I used to get by with an ice pak at the desk when I had one and I would be fine.  The worst one was in 2020 and my head was throbbing and then the nausea and, of course, you can't leave.  For me the nausea is the worst.  Thankfully my coworker let me turn the lights down at the nurses station and just rest my head on an ice pak. 

But usually I would be fine till I got home from a stressful shift and then when I should be able to relax my migraine would hit.  I always wondered why after, but am grateful it was not at work.  At least at home I could take some pain meds right away and compazine if I needed it.  When I was younger I had headaches that would last up to 24 hours and the only thing I could do was sleep them off.  If I waited too long nothing worked and for me the nausea was the worst.  The headache would usually be like a gnawing or throbbing and ice paks helped.  There was definitely a genetic component as most of the females on my mom's side of the family had migraines.

Also my neurologist had me try elavil and later topamax and then neurontin at the end.  I even had botox a few times which does work nicely but is very expensive.   I had triptans but was afraid to take them due to my high blood pressure.  That too has improved since I quit.  Fascinating fact topamax will break a soda addiction because it makes it taste like thick syrup and makes it undrinkable.   Elavil will help with chronic pain and even insomnia and may brighten your mood, though they use a low dose now vs the old antidepressant dose.  I'm sure the neurontin helped keep me calm during the chaos of 2020 so I'm grateful for that.  The downside is topamax and neurontin can affect your memory and I definitely noticed a decline in my short term memory.  Thankfully I'm glad to say I no longer need those meds anymore and hope my short term memory returns to normal.

I would recommend anyone with chronic migraine to see a neurologist as there are many treatment options now to help prevent them and stop them in their tracks if you get one.  There is no need to suffer.  You can get relief!

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Specializes in ER.

What about going home because you are sick? Why is it that a nurse is expected to stay at work while having an excruciating headache?

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Specializes in Critical Care.
25 minutes ago, Emergent said:

What about going home because you are sick? Why is it that a nurse is expected to stay at work while having an excruciating headache?

It was very rare to be able to leave, save a family emergency or nurse that went to the ER such as a nurse that fainted.  After the  corporate takeover where I worked we worked short and there wasn't anyone to take your place, especially at night. 

If you are sick it is best to call in vs expecting to go home, at least management would have time to look for a replacement.  But that doesn't preclude a migraine starting while you are already there in the midst of a 12 hour shift.  For me to leave my coworker would have had to take 10-12 patients by themselves. 

A day nurse even stayed while pregnant and cramping and ended up having a miscarriage.  I don't know if it would have been prevented by leaving right away, but if that was me I would have left regardless.  Plus on the day shift there are more nurses and supervisors that could take an assignment if need be, as well as a greater chance of being able to call someone in extra. 

But you get to the heart of the problem is that nurses are treated as too essential to leave, whether we are sick or if they didn't staff enough nurses the next shift, then they would force you to work 16 plus hours.  Coworkers would try to help each other if someone was sick or had an appointment and take a voluntary mandate out of turn.  But this is only happening because corporate management has chosen to staff so lean of a workforce they have no contingency plan for call outs, let alone nurses getting sick midshift.  They could choose to have more staff in the first place and an ample float pool, but are too cheap!  I think it will take federal legislation banning mandatory overtime and enforcing safe patient ratios like CA has for things to change.

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Specializes in NICU (neonatal).

Fortunately I don't get migraines and I rarely have headaches. But, I remember one night working in the NICU, I was in a pod with 3 babies, all under photo tx. By the end of the night I had a terrible headache. It was horrible! 

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Specializes in Neuro ICU.

Frequent migraine suffer here. And I've had to work many shifts with them. When I don't take the time to rest during my migraines I have a much worse post drome or migraine hangover as they call it. My brain will feel foggy for 1-2 days after. What helps me is to write every thing down so if the intensivist rounds and asks me about my patients I can just read off the paper. Ice packs are great for the pain, stretching my neck often, and eating something light. 

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