Mechanisms of Migraine As a Chronic Evolutive Condition Discussion
Lecturio Reflection and Analysis Signature Assignment
Instructions:
Compose a 300-400 word analysis of the related conditions (Headaches and Migraines). Compare three or more related conditions in the following areas: clinical manifestations, risk factors, differentials, diagnosis, and management/treatment recommendations. Use the table below to organize this information. (Conditions: Migraines, Cluster Headaches, Tension Headaches).
Lecturio Series
Condition #1 Migraine Condition #2 Cluster Headaches Condition #3 Tension Headaches
Clinical Manifestations Migraine has a variety of clinical manifestations and which vary in every individual. The main symptoms include throbbing in a certain head area with varying intensity, nausea, vomiting, light sensitivity, and nausea (Andreou & Edvinsson, 2019). The main clinical manifestations of cluster headaches include severe pain around or in one eye or individual’s head. The main symptoms include runny nostrils and nasal stuffiness on the affected head (Wei & Goadsby, 2021). The main way to identify cluster headaches is that it strikes quickly and has no warning, even if one may experience a migraine-like aura or nausea. The main clinical manifestations of tension headaches include shoulder muscle, neck, and scalp tenderness, tightness across one’s forehead, back, and side of the head, and dull aching head pain (Naprienko et al., 2019). Mechanisms of Migraine As a Chronic Evolutive Condition
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Discussion
Risk Factors There are various migraine risk factors, such as genetics and age. For genetics, Andreou and Edvinsson (2019) accentuate that about 75 % of individuals with migraine tend to have first-degree relatives who also had the condition from either parent’s side. On age, Andreou and Edvinsson (2019) posit that migraine’s onset may be at any age but mainly can be noted during adolescence but picks up during the thirties. That is why most girls tend to experience the onset of migraine during their first menstrual and are more prevalent for women at the childbearing age. The main risk factors include environmental, hereditary, and lifestyle factors. Other risk factors include family history and head trauma (Wei & Goadsby, 2021). The main risk factors for tension headaches include stress, mental tension, fatigue, missing meals, and somatization (Naprienko et al., 2019).
Differentials The main differential migraine diagnoses include acute glaucoma, temporal arteritis, and meningitis. The main differential diagnosis for acute headache includes hypertension, brainstem syndrome, arteriovenous malformations, and allergen exposure. (Wei & Goadsby, 2021) The common differential diagnoses for tension headaches include cluster headaches, migraine, and secondary headaches like sinus headaches (Naprienko et al., 2019).
Management The first-line migraine treatment uses nonsteroidal anti-inflammatory and acetaminophen medications for moderate and mild migraines (Andreou & Edvinsson, 2019). However, for severe to moderate migraines, the first-line treatment is triptans. There are no cluster headaches treatments making the treatment goal to decrease the pain severity, prevent the attack and shorten the headache duration. In that regard, the best treatment is through verapamil tablets, which an individual must take daily (Wei & Goadsby, 2021). However, the patient must undergo an electrocardiogram since verapamil can lead to heart issues for different individuals. Tension management can be done through pharmacological and non-pharmacological treatments. For pharmacological treatment, it may include ibuprofen, acetaminophen, and aspirin to relieve the pain (Naprienko et al., 2019). On the other hand, non-pharmacological treatment may include relaxation, cognitive behavioral therapy, and acupuncture and are best for patients affected by pharmacological treatments, like pregnant women (Naprienko et al., 2019). Mechanisms of Migraine As a Chronic Evolutive Condition Discussion
*You may add additional columns as needed.
Continue your analysis by comparing the following:
1. What are the transmission factors and pathophysiology of these conditions?
2. What are the primary medical concerns for patients with these conditions?
3. What might be the primary psychosocial concerns for patients with these conditions?
4. What are the implications of these conditions for critical care and advanced practice nurses?
These charts may help in organizing information to answer the narrative questions:
Condition #1 Migraine Condition #2 Cluster Headaches Condition #3 Tension Headaches
Transmission Factors For Migraines, Transmission factors lie in genetics since individual families can easily inherit it. According to Andreou and Edvinsson (2019), 60 percent of the main reasons individuals experience migraines emanate from their genes. Such genes reflect the individual’s sensitivity to lifestyle factors that can easily trigger an attack. Like migraines, cluster headache has a genetic correspondence degree where the first-family members have higher chances of having cluster headaches diagnosis (Wei & Goadsby, 2021). Unlike migraine and cluster headaches, tension headaches are not associated with genetics, meaning they cannot be inherited. That is why Naprienko et al. (2019) accentuate that the main tension headaches etiology lies in muscular and environmental factors, with posture and stress being the significant leading causes.
Pathophysiology The migraine pathophysiology involves three phases; premonitory, aura, and headache. The premonitory phase starts three days before the headache phase and integrates the complex subcortical and cortical brain regions interplay (Andreou & Edvinsson, 2019). That includes brainstem nuclei and the hypothalamus, which tends to modulate nociceptive signaling. For the second phase, migraines associated with aura tend to be recurrent, unilateral, lasting for more minutes, and may affect an individual’s language/speech, sensory, and motor disturbances since the central nervous system is also affected (Andreou & Edvinsson, 2019). As a result, hyperpolarization and glial cell depolarization occur, thus spreading the depression-like events. For the headache phase, trigeminovascular system activation happens, a pathway usually appropriately characterized (Andreou & Edvinsson, 2019). That means, for migraines, enhanced pathophysiological process characterization at each stage aids in the identification of new migraine prevention therapeutic targets. The cluster headaches pathophysiology integrates trigeminal-autonomic reflex and trigeminovascular complex activation and is responsible for the prominent ipsilateral cranial autonomic and unilateral severe headache symptoms (Wei & Goadsby, 2021). Consequently, the circannual and circadian rhythmicity, unique to the cluster headaches, gets postulated to incorporate the suprachiasmatic nucleus and hypothalamus. Mechanisms of Migraine As a Chronic Evolutive Condition Discussion Regardless of the distinct clinical features, there is a higher possibility of misdiagnosing cluster headaches in patients with otolaryngologist symptoms. Generally, the cluster headaches prognosis is hard to predict since patients exhibiting episodic cluster headaches can easily shift towards cluster headaches (Wei & Goadsby, 2021). Also, longitudinally, cluster headaches may remit with an individual’s age and contain less frequent bouts with prolonged remission periods within episodes. Tension headaches, despite being common, their mechanism and pathophysiology are still unclear. However, as Naprienko et al. (2019) state, the current information concerning the nociceptive system indicates that tension headache derivative pain is from a muscular origin. Generally, myofascial or muscular pain usually presents as achy, dull, radiating, and poorly localized (Naprienko et al., 2019). However, the pain emanating from the cutaneous structures is non-radiating, localized, and sharp. Therefore, the assumption that pain originates from the muscles and relates to the higher resting muscle tension mainly corresponds with the up-to-date clinical knowledge on tension headaches and their derived treatment interventions (Naprienko et al., 2019). Mechanisms of Migraine As a Chronic Evolutive Condition Discussion
Clinical manifestations Migraines’ primary medical concerns include pain in the neck and face, dull pains, throbbing, and severe, frequent, and acute headaches. Consequently, other primary concerns include malaise, light-headedness, and dizziness (Andreou & Edvinsson, 2019). Also, there are visual factors that healthcare providers need to identify, including distorted vision and light sensitivity. Other areas affected include the gastrointestinal areas since the individuals may experience vomiting, nausea, and sensory areas, which involve sound sensitivity and aura. The primary medical concern for cluster headaches includes eyes where the individuals experience watery eyes, upper eyelid drooping, redness, and puffy eyes (Wei & Goadsby, 2021). Also, the whole body is affected, which is noted by nervous system dysfunction, flushing, and other times sweating (Wei & Goadsby, 2021). Also, other common symptoms include runny nose, agitation, and headache. The main symptoms of tension headaches include pain on both sides of an individual’s head, mostly linked with muscle pain. The pain mainly occurs in the neck, muscles, and face (Naprienko et al., 2019). Common symptoms include photophobia, phonophobia, sleep difficulties, and headache.
What makes this diagnosis unique from other differentials? The main factor differentiating migraines from other differential diagnoses is that it does not have a specific cause, even if it has common triggers like genetics and age (Andreou & Edvinsson, 2019). Hence, unlike other headaches, migraine’s cause cannot be traced easily. The distinguishing features of cluster headaches from other differentials are the unilateral intense pain features with short duration, circannual and circadian rhythm, and the prominent cranial autonomic features (Wei & Goadsby, 2021). Consequently, it is one of the most disabling and painful head-related disorders that humans experience. The differentiating factor of tension headaches from other differentials is that it presents discomfort and a steady ache in one’s head (Naprienko et al., 2019). The pain presents itself as distracting though not debilitating. Unlike migraine, one of the differential diagnoses that tend to present throbbing and severe headaches.
Guidelines and recommendations for condition management Migraine’s main management includes nonopioid analgesics, NSAIDs like aspirin, caffeinated analgesics, and acetaminophen, mainly for mild-to-moderate attacks (Andreou & Edvinsson, 2019). Consequently, migraine-specific agents like dihydroergotamine and triptans are used for severe and moderate attacks. However, the main recommendation includes assessing if the migraine is genetically related to help the healthcare professional determine the best intervention. The main guidelines and management for cluster headaches include ensuring high-flow oxygen and subcutaneous sumatriptan are recommendable cluster headache attack treatments (Wei & Goadsby, 2021). However, the other treatments include the usage of intranasal triptans, lithium, and verapamil as a first-line preventative treatment. The main recommendation includes engaging in home and lifestyle remedies (Wei & Goadsby, 2021). Home remedies include ensuring one stick to a regular sleep schedule and lifestyle to avoid or reduce alcohol consumption. Aspirin is always referred to as the first-line treatment for tension headaches, regardless of the intensity of the headache (Naprienko et al., 2019). However, various modalities for tension headache treatment include cold and hot packs, electrical stimulation, ultrasound, trigger point injections, posture improvement, relaxation techniques, and occipital nerve blocks (Naprienko et al., 2019). However, it is recommended that individuals exercise regularly, consume balanced meals, and get adequate sleep. Mechanisms of Migraine As a Chronic Evolutive Condition Discussion
Potentially related safety issues The main safety issues related to migraines include their association with ischemic strokes, which may sometimes lead to mental health issues (Andreou & Edvinsson, 2019). According to Andreou and Edvinsson (2019), individuals with cluster headaches have higher chances of developing various mental health issues like depression and heart disease. In most cases, tension headaches are not linked with serious health problems. However, Naprienko et al. (2019) indicate that the disorder may lead to strong mental health disorders like anxiety and depression.
References
Andreou, A. P., & Edvinsson, L. (2019). Mechanisms of migraine as a chronic evolutive condition. The Journal of Headache and Pain, 20(1). https://doi.org/10.1186/s10194-019-1066-0
Naprienko, M. V., Filatova, E. G., Smekalkina, L. V., & Makarov, S. A. (2019). Tension headache. Let us get a second look. Consilium Medicum, 21(2), 79–85. https://doi.org/10.26442/20751753.2019.2.190281
Wei, D. Y., & Goadsby, P. J. (2021). Cluster headache pathophysiology — insights from current and emerging treatments. Nature Reviews Neurology Mechanisms of Migraine As a Chronic Evolutive Condition Discussion