Neurological disorders affect people of all ages, every day, and everywhere in the world. Our senses stem from the neurological system, the ability to taste, smell, hear, see, and touch are the main five senses. When one of these senses is affected our body reacts to it, however there are other senses affected such as the vestibular system that tells our body where we are spatially in the universe and proprioception that helps us gage strength, and ability to do the things we do firmly, or gently. This paper will discuss migraine headaches, share how behaviors can influence the headache and affect medications for headaches, share drug treatments, measures that can decrease symptoms, and organizations available that can help give information to patients affected by the disorder.
Pathophysiology of Migraine Headaches
Headaches are common disorders of the neurological system, but they can also signal underlying disease such as tumors, meningitis, or even brain bleeds per Huether and McCance (2017). They further share migraines can last four to 72 hours and a patient must have two documented episodes of criteria such as unilateral head pain, pain that worsens with activity, and the pain must be moderate to severe in nature. Patients must also have one of these criteria such as nausea, vomiting, photophobia, or phonophobia. Migraines can be with or without perceived auras that affect the visual, sensory, or motor pathways. (Huether and McCance, 2017) They further share the trigeminal vascular system is related to migraine pain, through the release of calcitonin gene-related peptide (CGRP), and that migraines have clinical phases such as a premonitory phase where the patient may be tired, irritable, or have a stiff neck. Migraine auras can accompany just before the migraine and can be visual,sensory, or motor. Headache phase such as throbbing pain, on one side but can spread to the whole head, cause fatigue, nausea, vomiting, dizziness and the recovery phase where the patient can experience continued fatigue, irritability or depression. Migraines are wose than general headaches or tension headaches in that the symptoms are worse, last longer, and prevent the patient from doing anything besides heading to a darkened, quiet, room. When migraines become chronic, they are quite debilitating and can require medications to treat them, next we will look at treatments for migraines.
First line treatment in migraines is the salicylates and nonsteroidal anti-inflammatory (NSAIDs) for mild to moderate migraines, with triptan type medications as first line for moderate to severe migraines. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) They further share second line treatment as over the counter caffeine compounds such as Excedrin when the salicylates and NSAIDS have not worked. If the migraine is severe the recommendation is to add Ergot derivative medications along with an antiemetic if triptan medications are not effective. Finally, is the third line medication treatments when all the above fail Butalbital or other opioids are recommended. Selecting treatment and trying medications can take months to find a combination that works and it is important to let the patient know this and assess if the patient is trying alternative or complimentary medicine practices along with medical science in the treatment of migraines as their can be drug interactions. Most of the medications used in migraine treatment require assessment of the cardiac status prior to use, and are not recommended during pregnancy. Several are affected by CYP3A4 pathways and therefore should not be used with inhibitors in that drug pathway. If a patient fails one triptan type drug another is tried as different medications can work better for some patients than others, the Butalbital and opioids are only used when all else fails due to addictability and the need to taper dosing prior to stopping these types of medications.
Behaviors Affecting Migraines and Migraine Medications
Patient behaviors can have an effect on migraines, too much sleep, too little sleep, alcohol, foods such as chocolate, and tyramine agents like red wine, stress, medications like vasodilators, hormones. Pretty much it seems life in general can be a trigger for some such as lower socioeconomical status, caffeine, smoking, and even loud noises, strong odors, weather, skipping meals, obesity. (Arcangelo, Peterson, Wilbur, and Reinhold, 2017) Often times we get busy with life and forget to slow down and take care of ourselves properly, it seems life is focused on getting ahead, or trying to fit into society rather than the health components that make life more enjoyable, and overall less costly. If one takes care of ones self, there is less expense for medical care and medication in general. Having patients keep a journal of their headaches can lead to triggers that are specific to that patient and this can help head off migraines but also help with finding medications to use specific to that patients condition. Educating on smoking and alcohol cessation, or adjusting diet if known triggers are found can help decrease symptoms and episodes of migraines.
Organizations are available to offer advice and support for patients that suffer with migraines such as the United States Headache Consortium, the Migraines.org which discusses facts and myths of migraines. Coalition for headache and migraine patients or CHAMP is a foundation to discuss migraines, find a cure and support patients and families dealing with chronic migraines.
While migraines are a disorder, and are neurologically related they can take time to diagnose, treat, and find triggers or behaviors that can affect the onset, duration, and occurrence of migraines. Working with patients to fully assess the type of headache, when it occurs, where it occurs, how long it lasts, how often it occurs, what worsens or alleviates it if anything, what kind of pain it brings such as stabbing, or throbbing, what medications or treaments they have already tried, and how it affects the patients life in that are they able to do anything when the migraine occurs. These are all questions as advanced practice nurses that will help guide diagnosis and treatment for migraine sufferers.