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Migraine Headaches
Sign and symptoms/Clinical presentation of disease process Treatment Evaluation
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).
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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…
References
Bigal, M., Lipton, R. (2008). The prognosis of migraine. Current Opinion in Neurology, 21(3): 301-308.
Goadsby, P. (2012). Pathophysiology of migraine. Annals of Indian Academy of Neurology, 15(1): 15-22.
Goldberg, L. (2005). Cost of migraine and its treatment. American Journal Managing
Care, 11(2): 62-67.
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