Bob, a 38 year old male, has intermittent headaches for about 10 years. When they occur, he experiences flashes of light in his right eye, followed by throbbing on the right side of his head. They frequently last 2-4 hours and is accompanied by nausea, occasional vomiting and photophobia.
1. Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache.
NSG 530 – Week 11
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NSG 530 – Week 11
Migraine is a highly detrimental primary headache disorder. In the presented study, the patient has had an intermittent headache for about 10 years. The headache is associated with flashes of light in the right eye, followed by throbbing on the same right side of the head. The headache normally lasts for about 2 to 4 hours and is associated with nausea, occasional vomiting, and photophobia. Based on the symptoms, the diagnosis of the patient is most likely to be a migraine. According to Eigenbrodt et al. (2021), migraines manifest ass recurrent attacks associated with a wide range of symptoms. Other symptoms of migraine include unilateral pulsating head pain accompanied by nausea and/or vomiting, photophobia, and photophobia. The chronic condition is also associated with symptoms of visual, sensory, or motor disturbances (Mungoven et al., 2021). Flashes or light and throbbing on one side of the eye and head respectively are symptoms of migraine.
According to Eigenbrodt et al. (2021), the pathogenesis of migraine is believed to be associated with central and peripheral activation of the trigeminovascular system. However, the underlying pathophysiology of chronic migraine is not fully understood and remains an area of research that is yet to be exploited. Due to this, migraine theories around migraine have evolves over time without consensus regarding its pathophysiology (Mungoven et al., 2021). Currently, there are two main schools of thought regarding the underlying mechanism of migraine. The first one suggests that migraines occur due to external triggers while the second theory suggests that migraines happen due to changes within the brain itself.
Mungoven et al. (2021) state that recent evidence has shown that symptoms such as tiredness and reduced concentration happen hours before the onset of a migraine. Experts believe that migraine is related to a dysfunction of subcortical sites below the level of the diencephalon, which results in an abnormal perception of the basal level of primary traffic. It has recently been suggested that brainstem activity fluctuates between the enhanced state, threshold state, and diminished tone state (Mungoven et al., 2021). At a diminished tone state, the ongoing endogenous analgesic circuits become ineffective to modulate the incoming noxious inputs.
Furthermore, in a diminished tone state, the trigeminal pathways can be activated by an external trigger which in turn leads to head pain; the opposite occurs when the brainstem is in enhanced tone (Mungoven et al., 2021). In addition, experts have suggested that hypothalamic function is crucial and might have some influence on changing the sensitivity of brainstem sites (Eigenbrodt et al., 2021). It seems that migraine is a complex condition with a synergistic relationship between the peripheral and central nervous systems. These two nervous systems are both involved in the pathophysiology of migraine.
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