Headache Disorders NSG 530

Instructions

Hello. Here is the post for week 11’s reply.

Please paraphrase as much as possible. Thank you.

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This week’s patient, Bob, has intermittent headaches that have been ongoing for more than ten years. Besides photophobia in the right eye, the patient also has throbbing in the right side of his head. According to these symptoms, migraine headaches are likely to be present. As described by Pescador et al. (2022), migraine is a genetically influenced complex neurovascular disorder characterized by periods of moderate-to-severe headaches that are usually one-sided and associated with nausea, light sensitivity, and sound sensitivity.

An extremely severe and disabling recurrent headache condition known as migraine. World Health Organization data show that migraine is the sixth most disabling neurological disorder worldwide (Goadsby et al., 2017). Various theories and hypotheses have been proposed about migraine\’s pathophysiology. It is widely accepted that trigeminovascular pathways, brain stems, and diencephalic nuclei contribute to migraine (Goadsby et al., 2017).

Close family members or relatives have an expected incidence of migraine, but the exact causative gene or inheritance pattern has yet to be determined (Pescador et al., 2022). Families with familial hemiplegic migraine (FHM) have been shown to have a genetic predisposition to migraine. (Burstein et al., 2015) The identified three genes encode proteins that regulate glutamate availability in the synapse.

The trigeminal hypothesis of migraine with aura is caused by spreading depression in areas where depolarization is not conscious (Pescador et al., 2022). Trigeminal afferents are activated by opening neuronal pannexin-1 mega channels and activating caspase-1 (Pescador et al., 2022). Proinflammatory mediators are released, NF-kappa-B is activated, and the inflammatory signal spreads to the pia mater\’s trigeminal nerve fibers around vessels.).).

The multiple symptoms, including aura and headache, suggest migraine is neurological, including brain changes, compared to nonmigraine headache brain (Burstein et al., 2015). Studies indicate that migraines are caused by neuronal hyperactivity. Migraine attacks have four stages: prodrome, aura, headache, and postdrome. Subsequent discussion will focus on the treatment options for migraine.

References

Burstein et al. (2015). Migraine: Multiple Processes, Complex Pathophysiology. Journal of Neuroscience. https://www.jneurosci.org/content/35/17/6619.full

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, 97(2), 553–622. https://doi.org/10.1152/physrev.00034.2015

Pescador et al. (2022). Migraine Headache. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/

Solution

Response

Hi,

I am pleased with the information you provided in your initial discussion based on the case study. I have a feeling that most people do not have a better understanding of the types of primary headache disorders. Migraine is one of the primary headache disorders whose pathophysiology is not fully understood (Eigenbrodt et al., 2021). I also feel that healthcare professionals have had less interest in understanding the underlying pathophysiology of migraine.

Therefore, this week’s discussion was an interesting and informative one. I am happy you recognized the diagnosis of the patient to be a migraine. The description provided in your discussion is simple and easy to understand. Therefore, this response will both support and add new knowledge to the initial discussion. According to Eigenbrodt et al. (2021), migraine is associated with attacks of headache accompanied by other symptoms that can be disabling to patients.

The headache attacks can be accompanied by neurological disturbances, known as migraine aura. Symptoms of migraine include nausea/vomiting, photophobia, flashes, and throbbing on one side of the head. These symptoms are similar to what the patient experienced, hence the diagnosis (migraine) (Mungoven et al., 2021). The pathophysiology of migraine alternates between central and peripheral activation of the trigeminovascular system. Doctors believe that migraine occurs due to a dysfunction of the subcortical sites below the level of the diencephalon, which results in an abnormal perception of the basal level of primary traffic.

There is an idea that brainstem activity alternates between enhanced, threshold, and diminished tones or states (Eigenbrodt et al., 2021). When brainstem activity is in a diminished state, the ongoing endogenous analgesic circuits become ineffective in modulating the incoming noxious inputs. At this stage, external triggers can activate the trigeminal pathways causing migraine. The vice versa happens when the brainstem is in an enhanced state.

Therefore, the pathophysiology of migraine is a bit complex. In addition to the pathophysiology, one is diagnosed with migraine after experiencing severe to moderate headache attacks associated with other identified symptoms lasting between four and seventy-two hours (Mungoven et al., 2021). People with chronic migraine experience the symptoms at least 15 days a month for at least 3 months and at least 8 of the headaches meet the criteria of migraine headache. Chronic migraines have an increased incidence of comorbid psychiatric disorders such as anxiety and depression.

References

Eigenbrodt, A. K., Ashina, H., Khan, S., Diener, H. C., Mitsikostas, D. D., Sinclair, A. J., & Ashina, M. (2021). Diagnosis and management of migraine in ten steps. Nature Reviews Neurology, 17(8), 501-514. https://doi.org/10.1038/ s41582-021-00509-5
Mungoven, T. J., Henderson, L. A., & Meylakh, N. (2021). Chronic migraine pathophysiology and treatment: a review of current perspectives. Frontiers in Pain Research, 52. https://doi.org/10.3389/fpain.2021.705276

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