NR 603 Week 1: Compare and Contrast Assignment (V2):
Migraine Headache and Post Concussive Syndrome
In this discussion we will compare and contrast the migraine headache with Post Concussive
Syndrome (PCS). PCS actually refers to a broad spectrum of signs and symptoms that can be
typically found in a patient after a head injury has occured, while a migraine headache is a
clinical condition that most often occurs without a head injury. They both can often present with
identical signs and symptoms. A thorough history and physical exam will be needed to determine
a definitive diagnosis.
Presentation
The typical patient with PCS will present with a history of head injury, which can be severe,
mild, recent, distant and even unknown in patients with amnesia. The signs and symptoms of
PCS can be divided into three categories. For example, somatic symptoms would include such
things as headache, fatigue, photophobia, phonophobia, double vision, nausea, vomiting, and
disturbed sleep patterns such as insomnia. Cognitive signs and symptoms of PCS include
difficulty concentrating, impairments in memory and attention and mental fatigue. Affective
signs and symptoms of PCS will include depression, emotional instability, anxiety, and mood
swings not normally seen before the injury (March & Karakashian, 2018).
The typical patient presenting with a migraine headache will exhibit some of the same signs and
symptoms as a patient with PCS, but include a few notable difference. Migraines rarely occur
after a head injury, but it is possible. A migraine headache can generally be classified into three
different type, prodronal, with an aura and without an aura. The “without aura” migraine
typically presents with classic unilateral head pain, nausea, vomiting, dizziness, photophobia,
phonophobia, insomnia, fatigue and sometimes clumsiness. Physical signs might include both
bradycardia and tachycardia along with both hypertension and hypotension, which can also be
found in head injury patients. The “with aura” type migraine will present with the same signs and
symptoms as the “without aura”, but with an associated visual disturbances such a blurred vision,
tracers, blind spots and possibly tunnel vision. The prodrome migraine will appear quite
differently with signs and symptoms such as stiff neck, photophobia, food cravings, depression,
hyperactivity, hypersomnia, thirst, diarrhea, anorexia and even constipation (Schub &
Parks-Chapman, 2018).
Pathophysiology
The pathophysiology of PCS has developed into an entire field of science and medicine. PCS is
generally considered to occur in the presence of mild traumatic brain injury with no obvious
, structural damage to the brain in neuroimaging studies (March & Karakashian, 2018). Because
of this lack of physical evidence, PCS is thought to occur on the cellular level. Understanding
what happens to the brain after an injury is helping doctors develop ways to treat PCS.
Researchers have recently discovered very complicated metabolic reactions in the brain that were
previously poorly understood. They found that while blood glucose levels rise in the body after
a brain injury, the brain consumes little glucose, and the cells of the brain consume larger than
normal amounts of oxygen. This discovery of neural cells using glucose and oxygen in atypical
ways, such as blocking organelles and powering cell wall pumps has led to research in better
treatment after injuries (Wright et al., 2013).
The pathophysiology of migraine headaches is also poorly understood and is thought to be
related to the trigeminal vascular system, which controls neurogenic inflammation, meningeal
vasodilation, and central sensitization of the brain. It has been shown that low levels of serotonin
can induce vasodilation on the brain's surface, but this connection is also poorly understood.
Certain conditions have been reported to trigger migraines such as pregnancy, menstruation,
hypertension, strong odors, tobacco use, motion sickness, and sleep deprivation. Some foods
have been reported to cause migraines, such as red wine, chocolate and some nuts. (Schub &
Parks-Chapman, 2018).
Assessment and Diagnosis
With both illnesses, the provider should conduct a thorough history and detailed physical exam.
A recent history of head injury lends itself to PCS, while a history of severe headaches and no
physical injury is concerning for a migraine headache. Question the patient about location and
severity, of headache, most migraines are unilateral with severe debilitating pain. There is not a
specific lab test for migraines, but serum and urine tests may help rule out infection, drug abuse,
or organ failure. Subarachnoid hematomas can often present with severe headaches, and can be
diagnosed with the help of cerebral spinal fluid sample. Migraines that occur less than 15 times a
month for three months are considered episodic, while more than 15 times a month for three
consecutive months are considered chronic (Schub & Parks-Chapman, 2018).
PCS will normally present after a head injury, but not all head injuries are appreciated or
remembered. Motor vehicle accidents can involve multiple injuries in a very short time period,
which can allow other injuries to mask head injuries. The provider should always perform a
detailed history and physical exam. It is important to determine a cognitive baseline of the head
injury patient with the help of family members or friends to help in the diagnosis. Information
such as duration, severity, and change over time, along with any symptoms that interfere with
daily life and work. Head injury screening tools, such as the Rivermead Post-Concussion
Symptoms Questionnaire (RPQ) is a scale used to measure the severity of PCS after a head
injury. The RPQ consists of 16 questions, measuring physical, behavioral and cognitive
Migraine Headache and Post Concussive Syndrome
In this discussion we will compare and contrast the migraine headache with Post Concussive
Syndrome (PCS). PCS actually refers to a broad spectrum of signs and symptoms that can be
typically found in a patient after a head injury has occured, while a migraine headache is a
clinical condition that most often occurs without a head injury. They both can often present with
identical signs and symptoms. A thorough history and physical exam will be needed to determine
a definitive diagnosis.
Presentation
The typical patient with PCS will present with a history of head injury, which can be severe,
mild, recent, distant and even unknown in patients with amnesia. The signs and symptoms of
PCS can be divided into three categories. For example, somatic symptoms would include such
things as headache, fatigue, photophobia, phonophobia, double vision, nausea, vomiting, and
disturbed sleep patterns such as insomnia. Cognitive signs and symptoms of PCS include
difficulty concentrating, impairments in memory and attention and mental fatigue. Affective
signs and symptoms of PCS will include depression, emotional instability, anxiety, and mood
swings not normally seen before the injury (March & Karakashian, 2018).
The typical patient presenting with a migraine headache will exhibit some of the same signs and
symptoms as a patient with PCS, but include a few notable difference. Migraines rarely occur
after a head injury, but it is possible. A migraine headache can generally be classified into three
different type, prodronal, with an aura and without an aura. The “without aura” migraine
typically presents with classic unilateral head pain, nausea, vomiting, dizziness, photophobia,
phonophobia, insomnia, fatigue and sometimes clumsiness. Physical signs might include both
bradycardia and tachycardia along with both hypertension and hypotension, which can also be
found in head injury patients. The “with aura” type migraine will present with the same signs and
symptoms as the “without aura”, but with an associated visual disturbances such a blurred vision,
tracers, blind spots and possibly tunnel vision. The prodrome migraine will appear quite
differently with signs and symptoms such as stiff neck, photophobia, food cravings, depression,
hyperactivity, hypersomnia, thirst, diarrhea, anorexia and even constipation (Schub &
Parks-Chapman, 2018).
Pathophysiology
The pathophysiology of PCS has developed into an entire field of science and medicine. PCS is
generally considered to occur in the presence of mild traumatic brain injury with no obvious
, structural damage to the brain in neuroimaging studies (March & Karakashian, 2018). Because
of this lack of physical evidence, PCS is thought to occur on the cellular level. Understanding
what happens to the brain after an injury is helping doctors develop ways to treat PCS.
Researchers have recently discovered very complicated metabolic reactions in the brain that were
previously poorly understood. They found that while blood glucose levels rise in the body after
a brain injury, the brain consumes little glucose, and the cells of the brain consume larger than
normal amounts of oxygen. This discovery of neural cells using glucose and oxygen in atypical
ways, such as blocking organelles and powering cell wall pumps has led to research in better
treatment after injuries (Wright et al., 2013).
The pathophysiology of migraine headaches is also poorly understood and is thought to be
related to the trigeminal vascular system, which controls neurogenic inflammation, meningeal
vasodilation, and central sensitization of the brain. It has been shown that low levels of serotonin
can induce vasodilation on the brain's surface, but this connection is also poorly understood.
Certain conditions have been reported to trigger migraines such as pregnancy, menstruation,
hypertension, strong odors, tobacco use, motion sickness, and sleep deprivation. Some foods
have been reported to cause migraines, such as red wine, chocolate and some nuts. (Schub &
Parks-Chapman, 2018).
Assessment and Diagnosis
With both illnesses, the provider should conduct a thorough history and detailed physical exam.
A recent history of head injury lends itself to PCS, while a history of severe headaches and no
physical injury is concerning for a migraine headache. Question the patient about location and
severity, of headache, most migraines are unilateral with severe debilitating pain. There is not a
specific lab test for migraines, but serum and urine tests may help rule out infection, drug abuse,
or organ failure. Subarachnoid hematomas can often present with severe headaches, and can be
diagnosed with the help of cerebral spinal fluid sample. Migraines that occur less than 15 times a
month for three months are considered episodic, while more than 15 times a month for three
consecutive months are considered chronic (Schub & Parks-Chapman, 2018).
PCS will normally present after a head injury, but not all head injuries are appreciated or
remembered. Motor vehicle accidents can involve multiple injuries in a very short time period,
which can allow other injuries to mask head injuries. The provider should always perform a
detailed history and physical exam. It is important to determine a cognitive baseline of the head
injury patient with the help of family members or friends to help in the diagnosis. Information
such as duration, severity, and change over time, along with any symptoms that interfere with
daily life and work. Head injury screening tools, such as the Rivermead Post-Concussion
Symptoms Questionnaire (RPQ) is a scale used to measure the severity of PCS after a head
injury. The RPQ consists of 16 questions, measuring physical, behavioral and cognitive
