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Migraine Headaches : Dacy Migraine Headaches : Dacy

Migraine Headaches : Dacy - PowerPoint Presentation

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Migraine Headaches : Dacy - PPT Presentation

Gaston Migraines Chief Complaint Ive been having really bad headaches that wont go away HPI Patient LR is a 28 year old Caucasian female that presents to the clinic with complaints ID: 627469

noted denies migraines migraine denies noted migraine migraines headaches normal pain treatment exam extremities unremarkable bilaterally intact midline pink

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Slide1

Migraine Headaches:

Dacy

GastonSlide2

MigrainesChief Complaint: “ I’ve

been having really bad headaches that won’t go away.”

HPI

: Patient

L.R

.

is a

28

year old Caucasian

female

that presents to the clinic with complaints

of headaches accompanied by nausea and sometimes sensitivity to light. The headaches are almost every other day, they last usually all day long and nothing alleviates them. They started about 4 months ago and have been getting worse. OTC Excedrin was the only thing that she has tried. Slide3

MigrainesPMH:

Anxiety/Depression-controlled being seen by psych Dr.

Family History

:

Father: Diabetes

, BPH

Mother

:

HTNSlide4

MigrainesMedications

:

1)

Wellbutrin 100mg

po

BID

2)

LoEstrin

28 1

po

q day

Allergies

: PCN

Surgical History

:

Gallbladder removal 2000 unremarkable

Slide5

MigrainesSocial History:

Denies recreational drug use, drinks 3x per week, usually on weekends. Lives with her boyfriend of 4 years, is finishing her undergraduate degree, has no children, exercises 4 times per week (jogging, treadmill), eats healthy diet.Slide6

Migraines (Review of Systems)General: denies fever, chills,

fainting.

HEENT

:

See HPI, denies

dizziness, vertigo, fainting or trauma. Last eye Exam was 6 months

ago-normal, PERLLA.

Denies changes in vision, pain, redness, double vision or discharge. Denies hearing impairment, tinnitus, earaches or infection.

Denies nasal discharge

, infection, nosebleeds or trauma.

D

enies

sore throat, voice changes, bleeding gums or hoarsenessSlide7

Migraines (ROS cont’d)Skin:

denies rash, itching, tingling, lesions or wounds

.

Neck:

denies dysphagia, tenderness, pain, or masses

Pulmonary:

Denies dyspnea, cough, sputum, hemoptysis, wheezing or asthma.

Cardiovascular:

Denies palpitations, orthopnea, edema or murmurs.

Gastrointestinal:

See HPI (nausea)

D

enies heart burn, reflux.

No change in stool pattern, denies blood-tinged stools, abdominal pain, constipation or diarrhea.

Extremities:

Denies coolness, tingling, loss of sensation or cyanosis.

Vascular:

Denies leg pain, swelling, leg cramps, ulcers or loss of hair on legs.

Urinary:

Denies burning, frequency, odor.

Musculoskeletal

:

Denies muscle or joint pain/tenderness/stiffness, muscle cramps, gout or weakness. Full ROM.

Neurological:

See HPI (headaches)

Denies

fainting, blackouts, weakness, paralysis, numbness, tremors, loss of memory, unsteady gait or speech disorders.

Endocrine:

Denies thyroid disorder, heat or cold intolerance,

changes in hair growth

. Slide8

Migraines (Physical Exam)Vital Signs:

BP

124/78

- HR

70

regular- RR

16

unlabored- Temp

98.2

– O2

100

%

Height:

5ft

6

inches

Weight:

124

BMI:

20.0-normal

General:

Patient is

pleasant 28

yr

old

Caucasian

female

who

appears to clinic in good spirits.

Sh

e

is AOx3, appropriately dressed and aware of

her

situation and surroundingsSlide9

Migraines (Physical Exam)HEENT: Head

nomocephalic

without

tinderness

, lesions or lumps. Hair evenly distributed, texture and quantity unremarkable. Facial features symmetrical an overall unremarkable, no weakness noted. PERRLA, EOM intact, Sclera clear, no redness or lesions present, conjunctiva pink without excessive vascularity. Cornea clear, no discharge or excessive tearing. Ear canals clear, no lesions or tenderness noted. Tympanic membranes bilaterally pearly gray with light reflex. No external exudate or bleeding.

Rhinne

: AC>BC bilateral. Webber: midline no lateralization. Nose symmetrical with no evidence of trauma. Nares patent, mucosa pink without discharge or swelling. Mouth mucosa moist, pink without lesions, tongue is midline, no coating or swelling present. Throat is moist, pink, uvula rises midline symmetrically with mild obstruction of uvula, gag reflex intact. Slide10

Migraines (Physical Exam)Neck: Full ROM, trachea midline, thyroid unremarkable, no lymphadenopathy.  

Skin

:

Warm to touch, no cyanosis.

T

urgor

good, nail beds pink with good capillary refill.

Pulmonary:

Lungs clear bilaterally, no crackles,

ronchi

, wheezing or

rales

. Unlabored

symmetrical

respirations. Tactile fremitus normal intensity and equal bilaterally.

Percussion

resonant in all lung fields. Vesicular breath sounds heard throughout.

No

egophony

, whispered

pectoriloquy

or

broncophony

noted

Cardiovascular:

Examined seated and supine. No abnormal pulsations, thrills or heaves noted. S1 louder at apex, S2 louder at base. No extra heart sounds heard, no murmurs, rub or gallop. Slide11

Migraines (Physical Exam)Vascular:

No JVD. All pulses 2+ bilaterally in upper and lower extremities. No bruits h

eard

. Negative Homan’s sign bilaterally.  

Abdomen:

U

nremarkable

to inspection, no visual abdominal pulsations.

Normoactive

bowel sounds in all 4 quadrants. Percussion dull from extra abdominal fat but noted throughout. Liver span normal, no

organomegaly

noted. No masses noted. No CVA tenderness noted. No bruit heard over aortic umbilicus. Scar noted from gallbladder removal, otherwise unremarkable.  

Extremities

:

Capillary refill <1 second, no edema, no clubbing noted.

Full ROM bilateral upper/lower extremity

.

 

Musculoskeletal:

Gait

within normal limits, full ROM all extremities. Spine midline with no deviation, normal curvature. No joint or muscle pain.  

Neurological:

AOx3 with no mental deficits noted. Cranial nerves intact. DTR’s intact,

2

+ upper and lower extremities. Sensory intact, no motor deficits noted. Gait normalSlide12

Migraines (Differentials/Diagnosis)Differential/Diagnosis:

1)

Migraines ICD-9: 346.00 (With/Without Aura/Chronic).

Chronic

migraine

is the most frequent complication of

migraine

. It is defined by the presence of headache on 15 or more days a month, of which at least eight must meet the criteria of

migraine without

aura

for a minimum of three months. In addition they must not be due to

medication abuse

or attributable to any other

cause

(

Carod-Artal

, F.,

Irima

, P.,

Ezpeleta

, D., 2012).

2)

Tension Headaches ICD-9: 307.81

3)

Cluster Headaches ICD-9: 339.00Slide13

Migraines (Plan)Plan

Management

of migraine is multifaceted and includes early

targeted and

multimodal approach for holistic treatment based on

bio-

psy

-

cho

-

ecological

nature. The first step in migraine management should be

1. Preventive treatment

2

. Acute treatment for pain treatment

(Singh, 2014)Slide14

Migraines (Management Cont’d)Prevention can be satisfactorily done by avoiding triggers migraine

producing

diet and drugs by pharmacological means and

keeping improved

health.

Treatment

of acute phase consists of pharmacological treatment

and alternative therapies.Slide15

Prevention of MigraineAvoiding triggers a) stress b) menstrual cycle in women c)

changing the

routine like sleep pattern or changing exercise pattern d)

avoiding the

changes in weather heat or high humidity and e) bright lights glare

or

reflected sunlight

Avoiding migraine foods

Chocolate, alcohol, particular wine, aspartame, monosodium

gluta­mate

,

fibre

, nitrates usually found in hotdogs bacon and

coldcuts

.

Tyramines

found in pickled or marinated food. Aged cheese and

yeast. Excessive

caffeine or caffeine withdrawal. Fasting or skipping meals.

Miscellenaous

triggers

Birth control pills, hormonal therapy, overuse of headache

medicine causing

rebound headaches, strong emotions like depression and

anxiety

(Singh, 2014)Slide16

Preventive pharmacotherapies come from following group of medi­cations and have established and significant efficacy in helping migraine patients

I. Beta blocker e.g. Propranolol,

Metoprolol

,

Atenolol 2

.

Antiepileptics

e.g. Divalproex,

Topiramate

(Topamax) 3. Serotonin

antagonists

e.g.

Cyproheptadine

and

Pizotifen

(Singh, 2014)Slide17

MigrainesReferences:

Carod-Artal

, F.,

Irima

, P.,

Ezpeleta

, D. (2012). Chronic migraine: definition, epidemiology, risk factors and treatment

.

Neurology Review,

54(10),629-637.

Singh, A. N. (2014). Diagnosis and Management of Migraine.

International Medical Journal

,

21

(3), 255-257