Migraines
The patient is a young female with a history of severe headaches on the right side. She has visited the emergency department six times in the last 2 months due to this headache. She reports that the headache usually lasts up to 2-3 days and has affected her concentration while working. Other symptoms associated with it are; nausea and vomiting, and light sensitivity. She has vomited thrice in the last 3 hours. She reports that her pain is a 10 out of a scale of 10 and can be relieved by acetaminophen and ibuprofen although not completely. She does not report any other current complaints. A diagnosis of migraines is suitable in this scenario (Cutrer, 2016).
Migraine is a common type of headache. It is a genetic disorder with first-degree relatives mostly affected. Neurological and musculoskeletal pathophysiologic processes are responsible for the symptoms of migraines. Neurological processes are the most fundamental. Most often, migraines have an aura. This is the neurological disturbance that is focal and manifests as visual, sensory, or motor (Cutrer, 2016). It affects the visual field of the majority. Commonly, tiredness, stiff neck, craving for sugar, and yawning occur premonitorily and are recognizable by patients.
According to Goadsby (2017), when the somatosensory cortex is affected, there is numbness of the hands and face with paresthesia. The motor cortex is also affected and brings about muscle weakness and tremors. When the basal ganglia or speech area is affected, clients report difficulty in saying words. Autonomic nervous system may be affected causing nausea and vomiting, frequent urination, yawning, diarrhea, and lacrimation. Cognitive symptoms include; lack of attention, aphasia, reduced concentration, and transient amnesia.
The pain is described as unilateral, throbbing, severe, and aggravated by movement or activity. The trigeminal nerve has been thought to propagate the pain with the ophthalmic division account for pain in the cranium while maxillary for facial pain. The joining of trigeminal and cervical afferents accounts for the pain and neck stiffness (Goadsby, 2017). It also depends on the sensitivity of the light, most of the people fell the throbbing pain on one side of the head. Other senses affected are smell and sound with patients complaining of abnormal sensitivity (Cutrer, 2016).
According to Kidd, & Nelson, (2018), musculoskeletal processes account for the weakness of the whole body. This is because the musculoskeletal system is primarily controlled by the nervous system. The stiff neck is due to the effect on the cervical spine. There is hypertonia in the paraspinal and suboccipital muscles. In familial hemiplegic migraines, the lower limbs are weak. Patients may report muscle tenderness. This accounts for intolerance to strenuous physical activity and movement.
Race and ethnicity have an impact on the prevalence of this condition. The Asian population is less likely to present with this condition. Other groups such as Hispanics and African-Americans are more likely to suffer from migraines than other groups including Caucasians. Race and ethnic differences interact with other contributing factors to bring about differences in the patients. African-Americans are more likely to suffer more severe and frequent attacks. They are also more likely to become chronic and are usually associated more with depression and low quality of life (Tao, F. 2017).
Even though Asians are less likely to get migraines, other factors such as hypertension, back, and neck pain make the migraines affect them even more. Therefore, healthcare professionals should pay keen attention to Asians with these conditions. Multi-racial patients are also more likely to suffer from the condition. This can be attributed to genetic vulnerability. The direct relationship between race and migraines has however not been established (Tao, F. 2017).
References
Cutrer, F. M. (2016). Pathophysiology of migraine. In Seminars in Neurology (Vol. 30, No. 02, pp. 120-130). © Thieme Medical Publishers.
Goadsby, P. J., Holland, P. R., Martins-Oliveira, M., Hoffmann, J., Schankin, C., & Akerman, S. (2017). Pathophysiology of migraine: a disorder of sensory processing. Physiological reviews.
Kidd, R. F., & Nelson, R. (2018). Musculoskeletal dysfunction of the neck in migraine and tension headache. Headache: The Journal of Head and Face Pain, 33(10), 566-569.
Tao, F. (2017). Migraine Prevalence and its Differences among Races and Ethnicities in the United States (2010-2015) (Doctoral dissertation, UC Irvine).