Critical Reflection and Pain

Migraine Headaches Sign and symptoms/Clinical presentation of disease process Migraine headaches are typically accompanied by severe head pain, eye pain, sensitivity to light/sound; symptoms can include nausea, vomiting, pounding head pain on one side of the head. Clinical presentation of migraine process: the headache will either be throbbing or pulsatile and will be unilaterally localized in the frontotemporal/ocular region of the head -- though pain can emanate all around the head and neck.

The pain will continue to build for hours and can last for more than 24 hours and sometimes for three days. Disease Background Anatomy: Four stages include prodrome, aura, headache, postdrome. Etiology: Precise etiology is unknown. Risk factors, however, include environmental factors, stress, serotonin imbalances, food, hormonal changes, alterations in sleep pattern, and medications. Pathophysiology: Development of the migraine begins with "alterations in the sub-cortical aminergic sensory modulatory systems that influence the brain widely" and proceed through to the four stages (Goadsby, 2012, p. 15).

Adult and geriatric consequences can be related to stroke. Epidemiology: One-year prevalence rates in the U.S. -- men from 4% to 9%, women from 11% to 25%. Non-Western countries report lower incidence rate across the board. Rates increase for persons over 30 years of age. Females between 30 and 50 from low-income households are at greatest risk (Manzoni, Torelli, 2003). Prognosis: According to Bigal and Lipton (2008), "prognosis is poorly studied" though more than 80% of those studied have migraine persistence for a year, while 10% experience remission and 3% develop chronic pain (p. 301).

Patient Education: Patients may be educated by doctors to avoid medications that could cause migraine, avoid stress, exercise, have healthy diets, etc. III. Treatment Evaluation Approach considerations: Quiet rest is one of the best treatment approaches along with OTC drugs or triptans (Goadsby, 2012; Manzoni, Torelli, 2003). Complications: Age, health and vulnerability to stroke can be factors. Health promotion and risk reduction: Healthy lifestyle including exercise, organic/natural diet, no smoking, no alcohol; stress reduction. Medicolegal Concerns: may arise during neuroimaging. Future research: Future research is needed on prognosis and cause.

Consultation: Can be arranged between doctor/nurse and patient. Long-term monitoring: This has helped to identify risks associated with migraine headaches -- such as stress, obesity, smoking, environment (Bigal, Lipton, 2008). Ethical/cultural consideration: Migraines are more common in the West and among women; concerns may be related to gender/sex issues, bias in terms of treating for hormonal disposition. Cost: Cost associated with migraine headaches -- $17 billion in the U.S. yearly (Goldberg, 2005). IV. Critical Reflection of interaction and investigation. Neuropathology of migraines may be investigated more fully. V.

Minimum of five test questions based on objectives and presentation. Three learning objectives: 1) What risks are associated with migraines? 2) What are the stages of migraines? 3) Who are most vulnerable.