Easily aggravated by physical activity, the common migraine can often have supplementary neck pain. With a diagnosis given after a minimum of five episodes, a common migraine is never preceded by luminous visual hallucinations, or aura, triggered by the vasoconstriction of arterioles and resulting reduced blood flow in the cerebral cortex.
A classic migraine is displayed very similarly to a common migraine, however, classic migraines are preceded by aura and a diagnosis is given after a minimum of two attacks. Rhea patient in this case study is suffering from a common migraine.
I arrived at this signoras by correlating her symptoms with those that characterize common and classic migraines. The patient complains of a “pounding and throbbing” headache Ninth pain that is unilaterally localized to her right temple and associated neck pain. Having been diagnosed with migraine headaches since the age of 9, with the preset migraine being the third one in the past month, the patient has exceeded the five- episode minimum required for a common migraine diagnosis.
Excessive consumption of caffeine, stress, depression, and photographs, are all factors that either potential or contribute to this patient’s migraine.
When a person suffers from depression, it has been found that there are low blood levels of serotonin. This patient has been diagnosed with major depressive disorder and was prescribed Philippine sulfate to combat her depression. Philippine sulfate is a potent nominee oxides inhibitor, or MAO’. MAXIS inhibit the actions of the enzyme nominee oxides. Nominee oxides, abbreviated MAO, functions to catalyst the oxidation of nominees.
There are two different types of MAO: MAO-A (nominee oxides A) and MAO-B (nominee oxides B).
One function of both Mass is to Inactivate certain neurotransmitters. MAO-A is responsible for the breakdown of serotonin, and both MAO-A and MAO-B breakdown dopamine. The resulting effect of an MAO drug, like the one prescribed to this patient, is an increase in serotonin, nonrecurring, and dopamine levels. The increased serotonin level is a desired result, functioning to help treat the patient’s depression. However, the inhibition of nominee oxides B causes increased levels of dopamine and nonrecurring, Inch can lead to hypertensive crisis.
In relation to the brain, hypertensive crisis often manifests as a headache. Photographs is sensitivity to bright light. The primary visual cortex is in the cerebral cortex of the brain. The release of serotonin initiates migraine headaches and increases the brain’s sensitivity to migraine-triggering stimuli. Photographs is a precipitating factor very common in migraine sufferers. When the patient went to discuss her migraine with her primary care provider, the bright lights in the clinic bothered her.
When light activates the primary visual cortex, the characteristic migraine-related pain brought on by the activation of the inceptive terminologically system potentates the activation, causing a sort of visual cortex hyper excitability. Chronic, or long-term, stress and the resulting release of stress hormones is a common trigger and precipitating factor for migraine headaches. This patient is constantly under a lot of stress from managing a divorce, her part-time Job, going to school at night and being a single parent to three sons.
The increased secretion of cortisone and other stress hormones, initiates the release of improprieties such as Substance P and calculation gene-related peptide. The instability of their release promotes vacillation that brings about inflammation and the activation of the terminologically system; the end result being a migraine.
The consequence of this patient’s high-stress life is an increased susceptibility to migraine headaches. Rhea over-consumption of caffeine on a regular basis is another behavior that can contribute to migraines in different ways.
When you regularly consume caffeine, your body becomes accustomed to its effect of vasoconstriction throughout the brain. If Ho do not consume enough caffeine to keep up that vasoconstriction, the resulting ‘stimulation will cause the throbbing pain associated with a migraine headache. En you consistently drink high doses of caffeine, it can cause a rebound headache, specially when combined with medications containing caffeine. This patient reported that over-the-counter (ETC) medications did not help her headaches.
Common ETC medications used for headache pain relief, such as acetaminophen and ibuprofen (which are also abortive pharmacological therapies), contain caffeine; taking either of these in tandem with the 3-4 caffeinated soft drinks this patient drinks daily, for example, can increase vulnerability to a rebound headache. Instead of these medications helping relieve the head pain, the combination of these caffeine-containing products will cause the person to relapse into another detach. 3. ) The patient has a sitting blood pressure of 135/90 and a lying blood pressure of 140/95.
Both of the patient’s blood pressure values are higher than the normal 120/80. Upon researching Philippine sulfate, the drug the patient was described for her depression, it warns users against the possible adverse effects from taking this drug with certain foods and drinks.
It has been found that if you consume large quantities tot chocolate and astatine while taking penalize sulfate, a resulting reaction will be an increase in blood pressure. This patient admits to eating “more hostage than she should” while also drinking 3-4 caffeinated soft drinks each day. His behavior, in combination with her prescription for epinephrine sulfate could be a factor contributing to her high blood pressure. 4. ) After reviewing this patient’s vital signs and measurements, it is clear that she is technically considered to be overweight. Body Mass Index, or IBM, is a measure of body fat in adults based on the individual’s height and weight. Dividing your weight in pounds by the value of your height in inches squared, and multiplying the quotient by 703 is the proper calculation of IBM. A IBM value between 25. ND 29. 9 IS classified as overweight.
When calculated, his patient’s IBM came out to 26. 6, classifying her as overweight. 5. ) The normal range for pupil size is a diameter of 2 to 4 mm. This patient has a pupil size of 3 mm, putting her within the normal range.
When testing a patient’s papillary response, a light is shone into each eye to test whether or not the patient’s pupils are reactive to light. Upon having a bright light shone into the eyes, a normal papillary response would be meiosis, the constriction or narrowing of the pupil. He mechanism by which the pupil constricts is under the control of two nerves. The efferent limb of this reflex, under the control of Cranial Nerve II (CNN II), the optic nerve, is responsible for sensing light entering the eye. Information is then conveyed to the calculator nerve, Cranial Nerve Ill (CNN Ill), whose parasympathetic limb Innervates the sphincter papillae muscle.
The sphincter papillae muscle functions to constrict the pupil in bright light. The data recorded for this patient indicated her eyes were reactive to light, indicating her papillary response was normal. . ) Upon reviewing this patient’s blood chemistry panel, an abnormal finding was noted. The normal magnesium (MGM+2) levels range between 1.
8-3. MGM/del, and this patient’s level was recorded at 0. 9 MGM/del, falling below the normal range. Magnesium plays an important role in the conversion of the amino acid thyrotrophic into serotonin. When someone is magnesium-deficient, it can lead to low levels of serotonin.
The vacillation of plasma protein extrapolations that causes inflammation, lead to the development of a migraine headache.
Therefore, this patient’s low blood levels of magnesium could possibly explain why she suffers from migraine headaches. Prophylactic pharmacological treatment is recommended if certain conditions are present in a patient suffering from migraine headaches. This patient is an appropriate candidate for prophylactic pharmacological therapy based on the nature of her history of migraines. This patient reported her current migraine as the third one of its kind in the past month. When the number of migraine attacks exceeds two per month, daily prophylactic pharmacological treatment should be considered.
She also reported that in the past, migraine headaches similar to her present one, lasted Jp to six hours and were unresponsive to over-the-counter (O medication. Medication, such as aspirin, acetaminophen, and ibuprofen are examples of common abortive pharmacological therapies. When attacks are prolonged and unresponsive to abortive therapies, daily prophylactic pharmacological treatment is recommended. Considering this patient’s migraines are synonymous to conditions meriting prophylactic pharmacological therapy, it would be appropriate for her primary care provider to prescribe a prophylactic pharmacological therapy regimen. .
) Immateriality, a tricycle antidepressant, is a drug that the primary care provider may prescribe as part of the initial prophylactic treatment for this patient’s migraine headaches. Tricycle antidepressants are particularly effective in migraine reversion for patients with a history of depression, much like this patient. Immateriality functions as a 5-HTH-receptor antagonist to inhibit the membrane pump mechanism that controls the eruptive of serotonin in serotonin neurons. Via this antagonistic mechanism, immateriality enhances serotonin mechanisms, stabilizing serotonin neurotransmitters.
This stabilized neurotransmitters will aid in the preventing the eventual activation of the inceptive terminologically system that causes the prolonged pain of migraines, which was ultimately caused by abnormal neuronal activity.
One precaution that the primary care provider should take is the potentially serious interaction of tricycle antidepressants with MAO medication. The drug this patient Nas previously prescribed for her major depressive disorder, epinephrine sulfate, is an MAO’.
The contraindication of MAXIS and immateriality could lead to dangerously high levels of serotonin in the blood, a condition known as serotonin syndrome, or it could cause high blood pressure. To avoid these adverse effects, the primary care provider should instruct this patient to stop taking the epinephrine sulfate at least 3-4 Knees prior to beginning her migraine prophylaxis with immateriality. 3.
) There are many features of this patient’s headache that reaffirm the diagnosis of migraine headache and exclude cluster headache.
This patient was previously diagnosed with migraine headaches at the age of 9 years old, putting her age of onset in childhood. The age of onset for cluster headaches is between young adulthood and middle age, while that of migraines is between childhood and young adulthood. This patient’s very young age of onset excludes cluster headache as a potential diagnosis. The onset and evolution of this patient’s head pain is slow-to- rapid, with the peak intensity being reached within one hour of onset. This is uncharacteristic of a cluster headache’s rapid evolution of pain.
Time course, characterized by frequency and duration, is a feature that differs greatly between migraine and cluster headaches. Migraine headaches occur episodically, meaning there is more time in-between attacks, and the attacks last for a longer period of time, anywhere from 2-72 hours. Cluster headaches occur more frequently and for shorter periods of time. Lasting on average anywhere between 15-180 minutes, the worth, recurrent nature of these headaches are said to occur “in clusters,” hence the name cluster headache.
This patient’s headaches last for about 6 hours and her present one being the third one in the past month, the nature tot nerd headaches are episodic, excluding the diagnosis of cluster headache. Characteristically, lactation and rhinoceros are two associated features that are symptomatic of a cluster headache.
Upon reviewing the initial history, this patient denies any occurrence of rhinoceros and lactation. The absence of these two symptoms makes ineligible the diagnosis of cluster headache.
Finally, one significant difference between migraine and cluster headaches is the nature of the pain. While cluster headaches tend to bring about a steady, non-throbbing pain, migraine headaches are typically described as a “throbbing” or “pounding” pain. The nature of the pain this patient presented to the primary care provider was a headache that Nas “throbbing” and “pounding,” a type of pain that is not seen in cluster headaches.
Part B 1 Migraine headaches show very strong gender susceptibility. Migraine headaches are significantly more common in women than they are in men.
As impaired to only 8% of men in the United States, 25% of women have had a migraine. Furthermore, 18% of women and only 6% of men have suffered a migraine over the previous year. The exact reasons for the predominance of migraine headaches in women are not known, however it is postulated to be the result of cyclic changes in estrogen levels during a female’s reproductive years.
As a woman progresses through the different phases of the ovarian cycle, there are notable cyclic changes in estrogen levels. Associated with these changes in estrogen, are changes in prostaglandin levels.
Formed from the actualization of arachnoids acid y callousness’s (COX), prostaglandin are locally acting messenger molecules with number of different functions. Prostaglandin cause vacillation, which ultimately Initiates an inflammatory response. As estrogen levels begin to increase gradually during the follicular phase of the ovarian cycle, the prostaglandin levels in the uterine endometrial also begin to rise. Rhea ululate phase, characterized by prolonged exposure to estrogen with increasing levels due to the corpus lutetium, also shows significant increases in prostaglandin levels.
Menstruation is triggered by the sharp decrease in estrogen during the late teal phase if fertilization does not occur. Prostaglandin levels continue to rise during menstruation, with maximum levels reached during the first 48 hours of menstruation. It is interesting to note that, studies have shown that migraines reported during menstruation most commonly occur on days directly before and after the first day of menstruation. During the first 48 hours of menstruation, when prostaglandin levels are at their highest, migraine headaches are more commonly reported than at any other time during the menstrual cycle .
This could be cause De by the prostaglandin qualities as a vacillator. When prostaglandin cause ‘stimulation, it initiates an inflammatory response, which in turn activates the terminologically system.
When this system is triggered, the inceptive terminologically system elicits the prolonged pain of a migraine. The increased entry of prostaglandin into systemic circulation prompted by increasing estrogen levels can produce the “throbbing” pain characteristic of migraines. Rhea actions of prostaglandin is not the only way in which cyclic changes in estrogen levels have the potential to cause migraines in women.
Estrogen withdrawal, the crease in estrogen after sustained high levels, is also a migraine trigger. Many Omen taking oral contraceptives get migraines during the pill-free week when estrogen levels plummet after 21 days of sustained high levels.
Another example of estrogen withdrawal triggering migraines is in pregnant women. During pregnancy, Omen report migraines less frequently during the second and third trimesters “hen estrogen levels are at a stable high. However, immediately post-part, when estrogen levels drop significantly, migraines are more frequently reported.
In natural hormonal events characterized by stable hormone levels, such as arrogance and post-menopause, the frequency of migraine headaches decreases significantly. Most evident in the post-menopausal period, when the ovarian cycle stops and estrogen levels are at a stable low with very little fluctuation, migraines are significantly less frequent.
Keeping the triggering factor of cyclic changes in estrogen levels in mind, there are a few different treatment options for migraine headaches.
A popular pharmacological abortive therapy is the use of Non-steroidal Anti-inflammatory drugs, or Nasals. Nasals inhibit prostaglandin synthesis by inhibiting the enzyme callousness’s. Inhibition of prostaglandin synthesis allows Nasals to function as an anti- inflammatory within the terminologically system to relieve migraine pain. Another treatment is the use of arrogating, a vasoconstriction that has been effective in preventing migraines that occur monthly at the same time according to the menstrual cycle.
While the idea of using oral contraceptives or hormone replacement therapy to treat migraines based on the idea of balancing hormones, the responses are very unpredictable. 2. ) One of the theoretical mechanisms of migraines involves an increase in glutamate and a decrease in magnesium. Glutamate is an excitatory neurotransmitter of great importance in the Central Nervous System. Magnesium Nothing the brain functions to block glutamate receptors and prevent excitability. Rhea link between neuronal hypercritically and its implications in migraines is a decrease in brain magnesium.
Low levels of magnesium in the brain cause impaired gating of glutamate receptors. Another consequence of low magnesium levels is the opening of calcium channels. With an increase in intracellular calcium, glutamate is released, extracurricular potassium increases, and together these factors are implicated in central hypersensitivity “hen levels of glutamate are increased, and there is a resulting neuronal hypercritically, the inceptive terminologically system becomes increasingly sensitive.
This assassination is responsible for the throbbing nature of migraine pain, as well as increases in headache intensity. Low magnesium levels can be correlated Ninth the frequency of migraine headaches. An acute prophylaxis for patients with low magnesium-induced migraines would be to take magnesium or calcium channel blockers to reduce the frequency of migraine headaches.