Migraine Headache Case Study

Neuro MS120 LecNotes
• Headaches
• Cluster Headaches: unilateral, around or behind the eyes, not familial
• Patho: Vasospasm r/t histamine release (allergies)
• Manifestations: tearing, running nose, photophobia, bradycardia, B/P changes
• Treatment: Similar to migraine headaches
• Tension Headaches: Muscle tension around forehead, neck and shoulders
• Patho: Tension at neck and shoulders
• Treatment: muscle relaxors
• Migraines are episodic, familial, experienced the same way every time
• “I’m having a migraine”: Proceed with a neuro assessment, pain scale, ask them what the typical course of the migraine is.
• blurred vision, photophobia, ptosis
• Etiology: Vasospasm in the brain leading to intermittent hypoxia of the brain
• Manifestations: How does the patient experience their typical migraines?
• Prodrome phase: Mood change, food craving, sensation. Anything that indicates that a migraine is coming
• Aura phase: Visual changes
• Headache phase: When the patient is experiencing the headache
• Termination phase: Headache is improving, but pain is still present
• Postprodrome phase: Headache pain gone, but neck may begin to fill stiff and achy, feelings of fatigue
• Treatment: Pain meds, antiemetics (for nausea), quiet/dark room, caffeine, ice packs
• Teach to avoid migraine triggers, encourage preventative therapy (yoga, meditation, acupuncture)
• Seizures:
• Primary: etiology unidentifiable
• Treatment: antiepileptics drugs, many interactions. Recent dx of seizures usually will require more than one drug for treatment. Watch labs for therapeutic ranges of AEDs
• Warn newly diagnosed patients to never stop taking meds.
• Secondary: Caused by something (tumor, trauma, f/e
imbalance)
• Generalized seizures affect both hemispheres vs local/focal seizures in a specific area that can progress to a generalized seizure
• Post-ictal phase: period after the seizure (lethargy, confused)
• Complex parital seizures: characterized by automatism
• Status epileptics: seizure lasting longer than 5 mins: Give lorazepam IV, intubate, general anesthesia w/ intubation
• Triggers: caffeice, flashing lights, alcohol, fatigue, physical activity
• When seizure patient is admitted: pad siderails, sunctioning, oxygen
• Treatment: Vagal nerve stimulation
• Multiple Sclerosis: autoimmune disease where plaque develop on myelin sheath of nerves in the spinal cord
• Relapse-remittant: periods of exacerbations that return to baseline.
More common. Will eventually progress to a secondary phase where the patient will get worse upon an exacerbation
• Common age of dx is 30-40
• Manifestations differ from patient to patient depending on where the plaques have developed
• Diagnosis: Lumbar puncture for CSF looking for high protein, high WBC, high ImG. EMG for musculofunction
• Treatment: treat neuropathic pain, slow progression and decrease severity, steroids (watch for hyperglycemia, GI bleeds), interferon, BRM (watch for flulike symptoms, fatigue, pancytopenia, depression), immunosuppression
(cytotoxic drugs). Encourage exercise and nutrition
• ALS Amyotrophic lateral sclerosis (Lou gherrig’s disease)
• No predictable progression, death occurs 2-5 years from dx, muscle degeneration leading to respiratory failure
• Reduce pain, provide comfort, promote quality of
life
• No mental changes other than depression and suicide because of prognosis
• Diagonosis: EMG, elevation of CK