Case Study Analysis

Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

· Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.

· Any racial/ethnic variables that may impact physiological functioning.

· How these processes interact to affect the patient.

· Severe right-sided headache, headaches that last for 2-3 days, nausea and vomiting, photophobia

-These symptoms are most likely caused by Migraine. Migraine is a neurological condition that can cause multiple symptoms. It’s frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages.

· There are some racial/ethnic variables that affect physiological functioning. As related to the scenario provided, the prevalence of migraine headache vary by race. In women, migraine prevalence was significantly higher in Caucasians (20.4%) than in African (16.2%) or Asian (9.2%) Americans. A similar pattern was observed among men (8.6%, 7.2%, and 4.2%). African Americans were less likely to report nausea or vomiting with their attacks, but more likely to report higher levels of headache pain. In contrast, African Americans tended to be less disabled by their attacks than Caucasians. There were no statistically significant differences in associated features between Asian American and Caucasian migraineurs. In the United States, migraine prevalence is highest in Caucasians, followed by African Americans and Asian Americans. While differences in socioeconomic status, diet, and symptom reporting may contribute to differences in estimated prevalence, we suggest that race-related differences in genetic vulnerability to migraine are more likely to predominate as an explanatory factor. (source: https://pubmed.ncbi.nlm.nih.gov/8710124/#:~:text=Results%3A%20In%20women%2C%20migraine%20prevalence,7.2%25%2C%20and%204.2%25).

· Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

Changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway, might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system. Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

CAUSES OF MIGRAINE:

· Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.

· Hormonal medications, such as oral contraceptives and hormone replacement therapy, also can worsen migraines. Some women, however, find their migraines occurring less often when taking these medications.

· Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.

· Stress. Stress at work or home can cause migraines.

· Sensory stimuli. Bright lights and sun glare can induce migraines, as can loud sounds. Strong smells — including perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.

· Sleep changes. Missing sleep, getting too much sleep or jet lag can trigger migraines in some people.

· Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.

· Weather changes. A change of weather or barometric pressure can prompt a migraine.

· Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.

· Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals or fasting.

· Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods. (source: https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201)

Neurological and Musculoskeletal Pathophysiologic Processes Related to Migraines

Upon review of the information presented in the case study (details above) the symptoms are most likely linked to migraine headaches. Migraines are a neurological condition that can present in patients with a variety of symptoms. Most often patients experience what are described as intense debilitating headaches, nausea, vomiting, sensitivity to light, increased sensitivity to sound, difficulty with articulation, and numbness and tingling sensations (Weatherspoon, 2017). Additionally, upon review of family history with patients, there is often a pattern of migraines within the family. Symptoms can last from just hours to sometimes days, and the pain often interferes with daily activities. Some individuals report presence of an aura before or during the headache period. These auras can cause flashing lights, blind spots, or the even the appearance of obstacles (Weatherspoon, 2017).

Racial

There are racial disparities that have been recognized when reviewing the population of those suffering from migraines. When reviewing women, migraine prevalence is slightly higher in Caucasian population. This has been documented as level of 20.4% Caucasian, 16.2% African American, and 9.2% is Asian Americans. Respectively similar patterns were noted when looking at males suffering from migraines (Chawia, 2019). This is scene as 8.2% Caucasian, 7.2% African Americans, and 4.2% Asian (Chawia, 2019). Research also shows that the racial impacts vary in terms of symptoms. African Americans were less likely to report nausea and vomiting but have higher levels of pain reported with migraines. African Americans however reported fewer debilitating factors. Research has additionally noted that socioeconomic factors can be identified in those reported to suffer from migraines. It is believed that this relates to diet, activities, and access to healthcare (Chawia, 2019). It is believed that when one looks at the racial disparities combined with genetic factors and socioeconomic facets there is reason to believe that these factors directly impact the diagnosis of migraines.

Process Interactions Impacting Patient

Research surrounding migraines still has left many unanswered questions in terms of why there is a wide disparity related to symptoms that are exhibited in patients. Changes in brainstem interactions surrounding the trigeminal nerve have been noted to be involved with migraines. There is additional research that shows correlation related to an imbalance in brain chemicals including serotonin levels, and calcitonin gene-related peptides (Chawai, 2019).

Additionally, there are numerous factors that can be related to the presence of migraines in a wide variety of patients. Hormonal changes in women are one of the most common causes listed for women suffering from migraines (Weatherspoon, 2017). Fluctuations in estrogen levels before/after menstrual cycles, pregnancy, and the onset of menopause all have been linked as migraine triggers. Related as well is the consumption of oral contraceptives and hormone replacement therapy which have been found to worsen migraines and reduce period between occurrences. Increased levels of stress are also related to migraines, as are the use of over the counter medications, and alcohol. Some may find that sensory stimuli can impact migraine occurrences such as bright light, sun glare, smells such as perfume, secondhand smoke, and even loud noises can trigger migraines. Environmental factors such as weather changes, especially that of increased biometric pressures can be linked to migraines. As can food additives such as monosodium glutamate, and aspartame (Weatherspoon, 2017).

Conclusion

Migraines are a prime example of a medical condition that has multiple variables that make treatment complex and challenging. As one can see in the information provided above there are significant disparities related to racial differences which this condition. Additionally, a multitude of factors are known to trigger migraines, and increase frequency. Recognizing these associations, and the disparities can help healthcare professionals to increase accuracy of diagnosis and fine tune treatment plans.

Neurological and Musculoskeletal Pathophysiologic Processes Related to Migraines

Upon review of the information presented in the case study (details above) the symptoms are most likely linked to migraine headaches. Migraines are a neurological condition that can present in patients with a variety of symptoms. Most often patients experience what are described as intense debilitating headaches, nausea, vomiting, sensitivity to light, increased sensitivity to sound, difficulty with articulation, and numbness and tingling sensations (Weatherspoon, 2017). Additionally, upon review of family history with patients, there is often a pattern of migraines within the family. Symptoms can last from just hours to sometimes days, and the pain often interferes with daily activities. Some individuals report presence of an aura before or during the headache period. These auras can cause flashing lights, blind spots, or the even the appearance of obstacles (Weatherspoon, 2017).

Racial

There are racial disparities that have been recognized when reviewing the population of those suffering from migraines. When reviewing women, migraine prevalence is slightly higher in Caucasian population. This has been documented as level of 20.4% Caucasian, 16.2% African American, and 9.2% is Asian Americans. Respectively similar patterns were noted when looking at males suffering from migraines (Chawia, 2019). This is scene as 8.2% Caucasian, 7.2% African Americans, and 4.2% Asian (Chawia, 2019). Research also shows that the racial impacts vary in terms of symptoms. African Americans were less likely to report nausea and vomiting but have higher levels of pain reported with migraines. African Americans however reported fewer debilitating factors. Research has additionally noted that socioeconomic factors can be identified in those reported to suffer from migraines. It is believed that this relates to diet, activities, and access to healthcare (Chawia, 2019). It is believed that when one looks at the racial disparities combined with genetic factors and socioeconomic facets there is reason to believe that these factors directly impact the diagnosis of migraines.

Process Interactions Impacting Patient

Research surrounding migraines still has left many unanswered questions in terms of why there is a wide disparity related to symptoms that are exhibited in patients. Changes in brainstem interactions surrounding the trigeminal nerve have been noted to be involved with migraines. There is additional research that shows correlation related to an imbalance in brain chemicals including serotonin levels, and calcitonin gene-related peptides (Chawai, 2019).

Additionally, there are numerous factors that can be related to the presence of migraines in a wide variety of patients. Hormonal changes in women are one of the most common causes listed for women suffering from migraines (Weatherspoon, 2017). Fluctuations in estrogen levels before/after menstrual cycles, pregnancy, and the onset of menopause all have been linked as migraine triggers. Related as well is the consumption of oral contraceptives and hormone replacement therapy which have been found to worsen migraines and reduce period between occurrences. Increased levels of stress are also related to migraines, as are the use of over the counter medications, and alcohol. Some may find that sensory stimuli can impact migraine occurrences such as bright light, sun glare, smells such as perfume, secondhand smoke, and even loud noises can trigger migraines. Environmental factors such as weather changes, especially that of increased biometric pressures can be linked to migraines. As can food additives such as monosodium glutamate, and aspartame (Weatherspoon, 2017).

Conclusion

Migraines are a prime example of a medical condition that has multiple variables that make treatment complex and challenging. As one can see in the information provided above there are significant disparities related to racial differences which this condition. Additionally, a multitude of factors are known to trigger migraines, and increase frequency. Recognizing these associations, and the disparities can help healthcare professionals to increase accuracy of diagnosis and fine tune treatment plans.

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