Case Study: Migraine Assignment Paper

Case Study: Migraine Assignment Paper

Case Study: Migraine Assignment Paper

This week’s case study focuses on a 24-year-old female administrative assistant presenting with a severe headache on the right side of the head which she grades at a 10/10. Her headache lasts 2-3 days and this is the sixth time she is experiencing such symptoms in two months. She has associated symptoms of nausea, vomiting, and sensitivity to light. Her diagnosis is most likely to be a migraine. The purpose of this paper is to discuss the neurological and musculoskeletal pathophysiology of migraine, their effects on the patient, and the racial variables that impact functioning.

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Neurological and Musculoskeletal Pathophysiologic Processes Associated with the Presenting Symptoms

Migraine has a myriad of pathophysiologic mechanisms. The most outstanding mechanism is the biological basis which dwells on the genetic nature of migraine headaches. The genetic mutations associated with the overexpression of migraines include methyl tetrahydrofolate reductase mutations and mutations in chromosome 19 involving the voltage-gated calcium ion gene (Dehghani & Karatas, 2019). Cortical depression is one of the neurological mechanisms of migraine. In cortical depression, there is depolarization of cells and a consequent release of pro-inflammatory cytokines. The associated features of nausea, vomiting, and photophobia are a direct consequence of meningeal irritation. The recurrent excitation of the trigeminal nucleus by inflammation triggers the release of pain mediators such as CGRP, Substance P, and Neurokinin A (Close et al., 2018). The headache pattern follows the distribution of the trigeminal nerve thus the one-sided nature of this type of headache. These symptoms affect the movement of a patient.

Ethnic Variables that may Impact Physiologic Functioning

According to Burch et al., (2019) migraines affect 12% of the global population. Migraine has a female gender predilection with towering prevalence occurring in post-pubertal women (Heslin, 2020). Racially, the prevalence is highest among Caucasians, followed by Africans, and least among Asians. Heslin, (2020) also discusses that the morbidity in migraines is dependent on the group’s socioeconomic status, age, gender, hypertension, the prevalence of depression, anxiety disorder, sleep disturbances, and the affordability of care. Together with the biological and the neurologic mechanisms, the ethnic variables increase patients’ morbidity in migraine.

How these  Processes Interact to Affect the Patient

The symptomatology of migraines such as severe headache, nausea, vomiting, and photophobia hinders one’s ability to work and is a cause of disability. This lowers the quality of life of an individual. Vomiting is a common cause of dehydration and metabolic derangements that can be fatal. Migraines tend to proceed to chronicity which greatly lowers the patient’s quality of life.

Conclusion

Headaches mostly manifest as a symptom of an illness but headaches can also exist independently as a primary disorder. Migraines can debilitate and incapacitate an individual. Therefore, headaches must be investigated and properly addressed.

References

Burch, R. C., Buse, D. C., & Lipton, R. B. (2019). Migraine. Neurologic Clinics, 37(4), 631–649. https://doi.org/10.1016/j.ncl.2019.06.001

Close, L. N., Eftekhari, S., Wang, M., Charles, A. C., & Russo, A. F. (2018). Cortical spreading depression as a site of origin for migraine: Role of CGRP. Cephalalgia, 39(3), 428–434. https://doi.org/10.1177/0333102418774299

Dehghani, A., & Karatas, H. (2019). Mouse Models of Familial Hemiplegic Migraine for Studying Migraine Pathophysiology. Current Neuropharmacology, 17(10), 961–973. https://doi.org/10.2174/1570159×17666190513085013

Heslin, K. C. (2020). Explaining Disparities in Severe Headache and Migraine Among Sexual Minority Adults in the United States, 2013–2018. Journal of Nervous & Mental Disease, Publish Ahead of Print. https://doi.org/10.1097/nmd.0000000000001221

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Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.
Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
Explain how the highlighted processes interact to affect the patient.
Explain any racial/ethnic variables that may impact physiological functioning.