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1Area of focus for week 1 quizMigraineAssessmentIt is important that the patient characterize the headache by describing the duration, quality, and location ofthe pain. The presence or absence of any precipitating factors, or triggers, and the age at onset should beestablished. The presence of associated symptoms, such as nausea, vomiting, and photophobia, should beexploredA medication profile is essential and should include medications that have been tried in the past forheadache control. If OTC medications are taken, the number used per month should be identified becausepatients may not view OTC drugs as medications.A targeted physical examination is important in ruling out harmful secondary headache pathologies andconfirms any information given in the history. 12 The examination findings in primary headache disordersare usually within normal limits.oKey aspectsof the physical examination include a cardiopulmonary and complete neurologicassessment with a major focus on the following:• Funduscopic and pupillary assessment •Auscultation of the carotid and vertebral arteries •Mental status examination •Palpation of the head, neck, and temporal arteries •Evaluation for any neck stiffness, focal weakness, sensory loss and gait •Vital signsProblem findings include:Onset of headache after the age of 50 years• Asymmetry of pupillary responses• Decreased deep tendon reflexes• Headache described as “the worst ever experienced”• Personality change• Onset of a new or different headache• Onset of a headache that progressively worsens• Papilledema• Painful temporal arteriesDiagnosisThe use of diagnostic studies depends on the results of the history and physical examination.If the diagnosis is not clear or the history or physical findings are cause for concern, diagnostic studiesshould be used to distinguish primary headache from a secondary condition.TreatmentNonpharmacologic measures attempt to control the headache without medication. These methods includebehavior modification, biofeedback, acupressure, management of headache triggers, and a wellnessprogram.Preventive therapy is appropriate for patients if they are unable to deal with their attacks, they experiencemore than four headaches a month, or the attacks are prolonged and refractory to medicine. Preventivetherapy is given daily and, if successful, will decrease headache intensity and frequencyFor example, a connection has been shown between epilepsy and migraine; therefore anticonvulsants, suchas divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax), can be used tocontrol migraineA patient with cold hands, Raynaud phenomenon, or hypertension may do well with calcium channelblockers, such as diltiazem (Cardizem) and amlodipine (Norvasc), which cause vasodilation and decreaseblood pressure.

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Term
Fall
Professor
N/A
Tags
Traumatic brain injury, Headache

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