| Learning Objective #1: identify four common manifestations of migraine using an assessment tool fomat in order to differentiate between migraine with and without aura. | |||
| Learning Objective #2: describe the evidence based practice for managing patients with migraine headache. |
Migraine Headache: Improving Diagnosis
Objective: The purpose was to identify the prevalence of headaches, assess patient management, and to identify interventions to improve diagnosing migraines. Migraine affects 1 in 10 adults and decreases work performance exponentially (Brandes, Saper, Diamone, et al, 2004). 14 million Americans are undiagnosed or misdiagnosed (HIS, 2004). Studies indicate the importance of using preventive/abortive medication as early as possible to have the most impact (Wright, 2005; Diamond, 2005).
Sample & Setting: The sample consists of 291 young adults, aged 18- 24, seen by nurse practitioners at an urban northeastern university clinic.
Methodology: A researcher-developed checklist (symptoms, family history, number of visits for same diagnosis, co-morbidities, treatment, and response to treatment[s]) was used to collect data for this retrospective study.
Findings: Case analysis of 389 chart entries of 291 student charts revealed the individualized assessment of symptoms, presence/absence of family history, co-morbidities, and treatment. There was a 35% lack of treatment response noted. NSAIDS were used 69%, tryptans 22%, and the remaining 9% included anti-epileptics, beta blockers, and complementary medicine. 66% were women and 34% were men. 34% returned for further work-up. Diaries were used 17% of the time. No consistent pattern of co-morbidities was identified. Only 41% were diagnosed with migraine, 1% with cluster, 35% with tension, 22% with sinus headache, and 1% were attributed to trauma. Students missed multiple activities and felt the headaches negatively impacted their college success. The primary complaint included not knowing when a headache would occur followed by feeling dependent on drugs, and fearful of ramifications of headaches. Conclusions: Using patient diaries, diagnostic assessment tools (Lipton, Dodick, Sadovsky, et al, 2003), and scheduling follow-up visits to track effectiveness of treatment generated improved identification of migraineurs.
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