A nurse is caring for a client who has headaches.
In determining a diagnosis, which of the following precipitating factors is common in both tension-type headaches and cluster headaches?

Choice A rationale

Avoiding warm water for facial washing is generally unrelated to cranial nerve IX (glossopharyngeal) or X (vagus) impairment. These nerves primarily affect swallowing, gag reflex, and vocal cord function, not facial sensation or hygiene temperature responses. Facial sensation is predominantly mediated by the trigeminal nerve (CN V), and facial motor control by the facial nerve (CN VII).

Choice B rationale

Applying an eye patch to the right eye is indicated for impairment of the facial nerve (CN VII) or trigeminal nerve (CN V), which can lead to lagophthalmos or corneal abrasions due to incomplete eyelid closure or decreased sensation. Acoustic neuroma primarily affects CN VIII, but its growth can sometimes impinge on adjacent nerves, including CNs V and VII. However, the question specifically mentions CN IX and X impairment.

Choice C rationale

Impairment of cranial nerves IX (glossopharyngeal) and X (vagus) significantly affects the gag reflex and swallowing mechanisms, increasing the risk of aspiration. The glossopharyngeal nerve is crucial for the afferent limb of the gag reflex and initiates swallowing, while the vagus nerve controls pharyngeal and laryngeal muscles. Therefore, having suction equipment readily available is a critical safety measure to manage potential aspiration events and maintain airway patency.

Choice D rationale

Providing range-of-motion exercises to the client's neck and shoulders addresses musculoskeletal concerns and is not directly related to the physiological deficits caused by impairment of cranial nerves IX and X. These nerves are involved in functions like speech, swallowing, and parasympathetic regulation, not in the motor control of the neck and shoulder musculature, which is primarily managed by cervical spinal nerves and the accessory nerve (CN XI).

Choice A rationale

Migraine headaches are classically characterized by unilateral, throbbing pain, often preceded by a prodrome including photophobia (sensitivity to light) or phonophobia (sensitivity to sound), and have a strong genetic predisposition, frequently running in families.

Choice B rationale

Cluster headaches are typically characterized by severe, unilateral pain located around the eye or temple, often accompanied by autonomic symptoms like tearing or nasal congestion, but they are not commonly described as throbbing or associated with photophobia as a premonitory symptom.

Choice C rationale

Tension-type headaches are usually described as a bilateral, pressing or tightening sensation, often mild to moderate in intensity. They are generally not throbbing, unilateral, or associated with significant photophobia as a prominent premonitory symptom.

Choice D rationale

Frontal-type headaches are a descriptive localization of pain rather than a distinct headache type. While pain may be in the frontal region, this term does not encompass the specific clinical characteristics like throbbing nature, premonitory photophobia, and family history indicative of migraine.