Migraine is one of the most common and controversial health conditions children and adults face over the lifespan. Goadsby, Lipton, and Ferrari (2002) describe it as a "chronic, incapacitating neurovascular disorder, characterized by attacks of severe headache, autonomic nervous system dysfunction, and in some patients, an aura involving neurologic symptoms" (p. 257). In developed countries, 15 percent of the adult population is affected by the disease (Edvinsson & Linde, 2010). Given the chronic nature of the disorder, every person diagnosed with migraine headaches needs a well-developed plan of care.
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For a 24-year-old woman diagnosed with migraine headaches, the expected outcomes of care will include: reduced frequency and duration of headache as well as the presence and effective utilization of available self-management resources to reduce and prevent pain. To meet these goals, the plan of care will include a requirement to keep a diary for a period of at least two months. The daily log will have to incorporate the following information: date and time, headache occurrence, duration of pain, and possible triggers. The patient will have to be attentive and thorough in documenting the factors, which may contribute to headaches. Also, any actions to prevent headaches would have to be documented. The data provided in the diary will inform the development of comprhensive strategies to contain migraine headaches in the long run.
It is not uncommon for individuals with diagnosed migraine headaches to refer to certain environmental factors, which, in their opinion, trigger headache attacks (Andress-Rothrock, King & Rothrock, 2010). The triggers may include but are not limited to alcohol, menstruation, sleep patterns (the lack of sleep or its excess), certain food, odors, emotional stress, and missed meals (Andress-Rothrock et al, 2010). In this case, food triggers deserve particular attention. The growing percentage of individuals with diagnosed migraine headaches reports food as the most possible trigger of pain attacks. Different studies confirm that the percentage of such patients ranges between 12 and 60 percent (Finocchi & Sivori, 2012). The most common food triggers of migraine include cheese, alcohol, chocolate, and fasting (Finocchi & Sivori, 2012). Therefore, diet will be an essential element of the care plan for a 24-year-old woman with migraine. However, she will have to include the information on food triggers in her diary, so that the most problematic types of food precipitating headache attacks are identified and avoided. Also, the patient will have to follow the recommendations provided in relation to medications and self-management.
The plan of care will include two medications: Almotriptan and AAmitryptiline. Almotriptan is a triptan derivative, whose use in migraine is widely accepted, documented, and approved. The triptans are well-known for the number of pharmacological advantages such as evidence-based prescription instructions, consistent and selective pharmacology, and moderate side effects (Edvinsson & Linde, 2010). The mechanism of action includes three possible elements: peripheral neuronal inhibition, cranial vasoconstriction, and second-order inhibition of neuronal transmission (Edvinsson & Linde, 2010). Triptans are safe but may lead to the following side effects: sensations of warmth in various parts of the body, tingling and paresthesias, flushing and dizziness (Edvinsson & Linde, 2010). Amitryptiline will be administered at bedtime as a preventive method to avoid further headaches. Drowsiness is the likeliest side effect of amitryptiline (Edvinsson & Linde, 2010). Once the frequency of headaches is reduced to one-two episodes per months, amitryptiline will be excluded from the care plan.
Simultaneously, the importance of self-management and non-pharmacological techniques should not be ignored. As part of the proposed care plan, the patient will be advised to attend a counselor or courses to develop self-relaxation skills and learn techniques of stress relief. The patient will have to see the physician in six weeks to discuss possible changes in health.