Headaches have become a common cause of hospital emergency and primary physicians’ visits. Most headaches in young adults result from may be primary illness such as migraine or secondary disorder such as infection (International Classification of Headache, 2018). The patient is likely to suffer from migraine headaches. She presents with severe right-sided headache, photophobia, nausea, and vomiting. Migraine headaches have at least five episodes which last between 4hours to 72 hours unilaterally located, with nausea, photophobia, vomiting and maybe pulsation.
Pathophysiological features of migraine headache are based on the interaction between neural system and vascular system, inflammatory responses, and trigeminal neurovascular activation. Migraine has been linked to having a strong genetic component though no clear proof of heritability pattern. Adults usually have longer episodes of migraine lasting between 2 to 3 hours, and during which patients usually prefer dark and quiet room due to photophobia (Chou, 2018). A common cause of migraine is stress, infections, poor sleep, dehydration, and fatigue.
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In this case, treatment criteria begin by performing curial examinations, like history taking. Vital signs like the pressure, temperature, BMI are recorded. The nurse should enquire about any history of headaches that may be consistent with migraine. This patient may be diagnosed with migraines due to the associated previous episodes.
Diagnosis
If historical findings meet the migraine criteria, it is imperative to conduct laboratory diagnostic tests so as to rule out possible underlying illness other than migraine as recommended by Chou, (2018). The possible diagnostic test is to perform imaging tests for reassurance. I am likely to request MRI and head CT scan investigations. The MRI and CT scan reports can help in identifying possible infections, presence of tumors, bleeding in the brain so as to offered assurance for migraine treatment interventions.
Treatment Approach
Treatment criteria will involve three approaches; pharmacologic treatment, lifestyle modification, and preventive measures. The pharmacological treatment for this patient will be to prescribe triptan (4.7 sumatriptan) 100mg in case of failure to respond to medication such as acetaminophen and ibuprofen, triptans have been proven through systematic randomized control trials to be an effective alternative.
In order to maximize the effect of migraine treatment, Weatherall, (2015) recommends lifestyle modification and triggers reduction. The patient should be advised to offer frequent regimens with regard to meals, sleep, hydration and avoidance of stress as much as possible. Proper managing of lifestyle modification and triggers can help maximize the impacts of medication. Lifestyle modification will further help the patient to regain concentration at work.
In summary, headache, nausea, vomiting, and photophobia are major signs of a migraine. Migraine becomes a major possible diagnosis for the condition presented by the patient. Being an assistant administrator, the patient is likely to have passed through a number of stressors which is a major trigger for migraines. For assurance of the diagnosis, imaging tests such as MRI and head CT scan is recommended so as to rule out possible headache-related illness. Upon diagnosis, the patient will be managed so as to ensure concomitant medication is treated. Due to the failure of ibuprofen and acetaminophen, triptan should be prescribed and the patient monitored for about seven days to study how she responds for treatment and suggest if there is a need to alter the treatment intervention.
References
Chou, D. E. (2018). Secondary Headache Syndromes. CONTINUUM: Lifelong Learning in Neurology , 24 (4), 1179–1191. https://doi.org/10.1212/CON.0000000000000640
International Classification of Headache. (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia , 33 (9), 629–808. https://doi.org/10.1177/0333102413485658
Weatherall, M. W. (2015). The diagnosis and treatment of chronic migraines. Therapeutic Advances in Chronic Disease , 6 (3), 115–123. https://doi.org/10.1177/2040622315579627
