IHUMAN CASE FOR WEEK #9: 26- YEAR-OLD PATIENT: FREQUENT SEVERE HEADACHES

IHUMAN CASE FOR WEEK #9: 26- YEAR-OLD PATIENT: FREQUENT SEVERE HEADACHES
What is a migraine headache? - ✔✔ANSWER✔✔Severe headache caused by
extracranial vasodilation, activation of trigeminal sensory nerves causing release of
vasoactive neuropeptides, and sensitization of CNS sensory neurons.
What is the clinical presentation of a migraine headache? - ✔✔ANSWER✔✔Severe
enough pain to interfere with daily activities. Can present with or without aura (flickering
lights, spots, wavy lines, partial loss of vision, numbness, parasthesias, and speech
deficits). Pain worsens with activity, is unilateral, and is pulsating. Patient also has at
least 2 of the following: nausea, vomiting, photophobia, phonophobia, and osmophobia.
What constitutes the diagnosis of chronic migraine headaches? - ✔✔ANSWER✔✔Five
or more attacks fulfilling the criteria.
What is a tension headache? - ✔✔ANSWER✔✔Most common headache disorder (most
patients don't present for care) that is influenced by environmental factors. Usually
caused by muscle contraction and central sensitization to pain.
What is the clinical presentation of a tension headache? - ✔✔ANSWER✔✔Mild to
moderate severity, nonpulsating, band-like pressure or tightness, bilateral pain, no
systemic symptoms, and lasts less than 4 hours.
What is a cluster headache? - ✔✔ANSWER✔✔Uncommon headache produced by
decreased sympathetic/increased parasympathetic activity, as well as vasoactive
neuropeptide release and neurogenic inflammation.
What is the clinical presentation of a cluster headache? - ✔✔ANSWER✔✔Unilateral,
severe, intermittent, sharp/stabbing pain, parasympathetic symptoms (lacrimation,
rhinorrhea, sweating), occurring at night, patients are restless, and generally lasts less
than 10 minutes but repeats during the day.
What are the goals of therapy for migraine headaches? - ✔✔ANSWER✔✔Reduce
frequency and severity of attacks, improve quality of life, reduce medication escalation,
treat attacks rapidly to restore normal level of functioning, optimize self-care to
maximize cost effectiveness and decrease ER visits, and minimize adverse effects.
What are non-pharmacological treatments for patients with migraines? -
✔✔ANSWER✔✔Keep a headache diary (track triggers, frequency, severity, and
response to treatment), behavioral interventions (relaxation therapy, biofeedback,
cognitive-based therapy), environmental control (rest in quiet, dark area; use ice packs),
and healthy lifestyle (regular sleep, exercise, smoking cessation, and limited caffeine).
What are common triggers for a migraine headache? - ✔✔ANSWER✔✔Exertion,
menstruation, lights, noise, smells, tobacco smoke, sleep extremes, caffeine/withdrawal,
dairy products, fatty foods, chocolate tyramines, and alcohol.
What treatment considerations should be analyzed when looking at acute treatment? -
✔✔ANSWER✔✔Most effective if initiated in the first hour of symptom onset, nonspecific agents for mild to moderate attacks, migraine-specific therapies for severe
attacks, oral routes may be less effective, and medication overuse headache (limit
acute options to 2d/week to prevent rebound HA).

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