NR508 PHARMACOLOGY; Migraine Headache Case Study

NR508 PHARMACOLOGY; Migraine Headache Case Study. 35-year-old adult female comes to the office with complains of the gradual onset of a bad throbbing headache behind her right eye that gradually worsened over several hours, starting in the temporal area. She has difficulty thinking and performing duties at work, and doing housework because activity makes the pain worse. It started 8 hours ago. Reports sensitivity to bright light (photophobia) and to noise (phonophobia). Nausea and vomiting also present. States that her mother and sister have similar headaches. She has had these symptoms three days this month. Denies flickering lights, spots, or lines in front of her eyes. Also denies dizziness, diplopia, tinnitus, or speech disturbances. She has tried OTC Excedrin migraine medication as directed on the label without relief. H & P and neurological exam do not indicate any organic lying disease. Differential diagnosis is Migraine headache without aura. Notes McCance & Huether (2014) and Leik (2014) state that migraine headaches are the most common compliant presented in the primary care office or in the urgent care setting. Because of the limits required for the power point presentation, this author decided to discuss this topic. Fenstermacher & Hudson (2016) state characteristics most patients have a family history of H/A and that symptoms rarely start after 50 years of age. Symptoms for migraine without aura are: (1) lasts 4 to 72 hours (2) unilateral, pulsating, moderate-to-severe intensity, worsens with activity (3) at least one of the following during H/A: nausea, vomiting, photophobia, phonophobia (4) H&P and neuro examinations do not suggest underlying organic disease. To differentiate with Migraine with aura include the above symptoms are symptoms of aura that are transient and reversible symptoms that gradually develop over 5 to 20 minutes and last 60 minutes that include (a) visual: flickering lights, spots, lines, (b) numbness, (c) speech disturbance, (d)brainstem: diplopia, vertigo, tinnitus. McCance & Huether (2014) and Leik (2014) state that the pain is usually located behind one eye that usually begins in the temporal areas that are associated with vascular changes in the cranial arteries. Mayans & Walling (2018) states more women (18-26%) have these headaches when compared to men (9%). The Mnemonic for diagnosis of a migraine is POUND (p 245). Pulsating type of headache One day duration (4- 72 hours if untreated or treated ineffectively) Unilateral Headache Nausea or vomit Disabling headache