Read the following case study and answer the posed questions
Case #1: For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last about an hour. James can be headache free for months at a time, but the attacks always return.
1. Describe the pathology of a headache.
2. Based on the different etiologies for headaches which of those fit this patients situation?
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
4. Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/ Links to an external site.as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.
Case #2: Mr. Smith is a new patient with a history of recent stroke approximately 3 months ago. He was hospitalized in another state, but you don’t have his records now. The patient’s wife is extremely anxious and worried about him because he hasn’t been “acting right”. She wants him checked out. She does not think he had hypertension but adds “he does not like to go to doctors.”
1. Regarding the patient’s available history, create a detailed plan of care for this patient.
2. In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024 Links to an external site.. Based on these current guidelines what goals would you recommend for this patient to insure prevention of another brain ischemic event?
Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.
Answers
Case #1:
For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are
characterized by intense burning pain on one side of his head, accompanied by tearing in his eye and a
runny nose. When they strike, the attacks typically occur several times a day and usually last about an
hour. James can be headache free for months at a time, but the attacks always return.
Pathology of Headaches
Current knowledge suggests that a neuronal dysfunction leads to changes intracranially and
extracranially that account for migraine, including the four different phases of premonitory symptoms,
aura, headache, and postdrome. “ Migraine is thought to be a neurovascular pain syndrome with altered
central neuronal processing (activation of brain stem nuclei, cortical hyperexcitability, and spreading
cortical depression) and involvement of the trigeminovascular system (triggering neuropeptide release,
which causes painful inflammation in cranial vessels and the dura mater).” (Silberstein, 2018). There are
two different types of headaches primary and secondary. Primary headaches have no underlying cause
and make up the majority of headaches. Primary headaches include tension, migraine, cluster, atypical
face pain, trigeminal neuralgia, and benign paroxysmal headaches. Exogenous disorders typically cause
secondary headaches. Causes of secondary headaches include intracerebral bleeding, raised intracranial
pressure, infection, inflammatory disease, post-herpetic neuralgia, and referred pain.
Different Etiologies
Based on James’s symptoms, gender, and age, the headaches that best fit his situation are cluster
headaches. Cluster headaches are typically seen more in males than females. According to McCance &
Huether (2015), onset generally is at the age of 20-50, and given that James is 64 years old and has been
dealing with these for 15 years, this puts him right in the age range. “Cluster headache consists of severe
headaches on one side of the head. It is associated with symptoms that occur on the same side of the
head that the pain is taking place on, and which can include red or teary eye, runny or stuffy nostrils, and
flushing or sweating of the face” (American Migraine Foundation, 2019).
History and Physical
“Clinicians must be skilled in their understanding of different types of headaches, risk factors, family
history, and clinical features. Differential diagnosis is confirmed with CT, MRI, and EEG” (McCance, &
Huether, 2015, p 608). Additional information needed so that a proper diagnosis can be obtained,
includes family history, precipitating factors, any other symptoms that happen with or before the
migraine, such as nausea, vomiting, and hypersensitivity.
Evidence that Supports Migraine without Aura
Evidence that supports the diagnosis of Migraine without aura includes that the patient describes his
pain as an intense burning on one side of his head. Migraine without aura present on one side of the
head.
