Question

Case Study: Phoebe Tate, 53 year old who suffers from migraine headaches. She has had these all her life, and has seen neurologists off and on for management of her headaches. Lately, her headaches have interfered with her being able to work at her 10 hour a day job practicing law. Her BMI is 30, and she is a nonsmoker with no alcohol use. She has no speech deficits and is able to exercise, though headaches have recently caused her to need more sleep. Discuss your approach as a: registered nurse, physician, pharmacist, nutritionist, social worker, physical therapist, and speech therapist. (Note: some members of multidisciplinary team may not apply to all cases-consider each case separately to determine individual needs.)

Answer 1

MIGRAINE HEADACHE

It can cause severe or throbbing pain or a pulsing sensation, usually on one side of the head. It affect around 15 -18% of the female population and 6% of men.

In this case note, the patient , Ms. Phoebe Tate, a 53- year old women suffering from headache a long time. She consulted neurologists, but no improvement in her condition. Recently, her headache was worsen and she can't able to work properly.

Occupation - Practicing law ( She works 10 hours /day)

BMI- 30 ( Obese)

No history of smoking and alcohol consumption.

No speech deficit.

ROLE OF REGISTERED NURSE

Nurse are in a prime position to offer advise to patients with migraine, who may not wish to 'bother the doctor'. nurses can educate the following:

Diet and lifestyle

a) Importance of having regular meals.

b) Adequate intake of water.

c) Avoid caffeine and beverages.

d) Regular sleep pattern.

Ms Tate work continously for 10hours , so adequate sleep is essential. Sleep at least 7-8 hours everyday.

Here the patient is obese,so diet management is very important.Hence, consult with nutritionist.

Rate pain in a pain scale

Nurse should aware of the warning signs of underlying neurological condition.

Medication history

Medication history should always be taken. Many patients are unaware that they are overusing medication and have a perception that over- the counter products are not harmful, even consumed in frequent and high doses.

ROLE OF PHYSICIAN

1. Assess the duration, onset, intensity and severity of pain.

2.Family history of migraine.

3. The goal of treatment should be to minimise the effect of the condition on the individual life.

4. Assess any ongoing medical condition.

5. Prescribe Analgesics or NSAID.

ROLE OF PHARAMACIST

a)Take medication history.

b) Ask drug allergy.

c) Taking 2mg of ergotamine 1 at the onset of an attack may also be effective.

if this medicine used more than one week cause nausea, colic , cold extremites etc.

Triptans are 5-HT1 agonits and work effectively at releaving headache and migraine symptoms.

ROLE NUTRITIONIST

a) Ms Tale is obese . BMI is 30.

Normal BMI is between 18.5 TO 24.9.

Migraine , whether episodic or chronic , is co-morbid with obesity. The risk of migraine increases with increasing obesity status- from normal weight to overweight to obese. In addition, obesity increases the risk of someone with an episodic pattern of headaches transforming to a chronic pain.

Reduce weight.

Increase fluid intake.

Encourage low calorie diet.

Avoid fast food, fried food items and sugar containing product.

ROLE OF SOCIAL WORKER

Encourage diversional activities.

Long use of computer cause migraine, so reduce the use of computer.

ROLE OF PHYSICAL THERAPIST

Regular exercise.

Exercise atleast 20 minutes everyday.

Arrage exercise according to her likes and dislikes.

Inorder to avoid stress or anxiety encourage yoga and meditation.

SPEECH THERAPY

Currently she have no speech problems. Almost 50 % of patients with migraine experienced changes in speech during attack, mostly comprised of slowed speaking and decreases in the precision of articulation. So regular monitoring is essential.