illness powerpoint assignment

A.
 C.
 W.
 
 
Nova
 Southeastern
 University
 

Winter
 2014
 

According
 to
 the
 Mayo
 Clinic
 (2014):
 
}  “Intense
 throbbing
 or
 a
 pulsing
 sensation
 in
 one
 area
 of
 
the
 head”
 (p.
 1)
 
◦  Mine
 are
 always
 on
 the
 left
 side;
 the
 right
 side
 feels
 normal
 

}  “Accompanied
 by
 nausea,
 vomiting,
 and
 extreme
 
sensitivity
 to
 light
 and
 sound”
 (p.
 1)
 
◦  I
 get
 nausea
 and
 need
 to
 squint
 or
 shade
 my
 eyes
 with
 my
 
hand
 in
 normal
 room
 light
 

}  “Can
 cause
 significant
 pain
 for
 hours
 to
 days
 and
 be
 so
 
severe
 that
 all
 you
 can
 think
 about
 is
 finding
 a
 dark,
 
quiet
 place
 to
 lie
 down”
 (p.
 1)
 
◦  Mine
 last
 24-­‐36
 hours,
 with
 the
 major
 pain
 usually
 lasting
 
about
 12
 hours
 if
 untreated
 

}  10%
 of
 the
 population
 gets
 
migraines
 

}  More
 common
 in
 women
 than
 
men,
 3:1
 ratio
 

}  1/3
 of
 sufferers
 can
 tell
 one
 is
 
coming
 because
 they
 get
 an
 aura
 
beforehand
 

 
}  National
 Institute
 of
 Neurological
 Disorders
 

and
 Stroke
 (2014)
 

1)  Prodrome
 

2)  Aura
 

3)  Attack
 

4)  Postdrome
 

}  Stages
 can
 vary
 person
 
to
 person,
 migraine
 to
 
migraine
 

 
}  People
 do
 not
 always
 
go
 through
 every
 stage;
 
even
 Attack
 might
 be
 
skipped
 

 
}  Mayo
 Clinic
 (2014)
 

}  Hours
 before
 a
 migraine
 hits,
 some
 people
 know
 
one
 is
 coming
 because
 they
 feel
 (Mayo
 Clinic,
 2014):
 
◦  Grumpy
 or
 sad
 
◦  Hungry
 
◦  Sore
 in
 the
 neck
 

}  Normally
 lasts
 less
 than
 an
 hour
 and
 can
 happen
 before
 
or
 during
 Attack,
 stage
 3
 

 

}  Fred
 Michael
 Cutrer
 (2011)
 described
 the
 four
 types
 of
 
migraine
 auras
 
◦  http://www.youtube.com/watch?v=ML1ZIk5v_C4
 (1:57)
 

 

}  ABC
 News
 (2011)
 interviewed
 a
 reporter,
 Serene
 
Branson,
 who
 had
 an
 aura
 during
 a
 live
 broadcast
 and
 
asked
 her
 what
 it
 was
 like
 
◦  http://www.youtube.com/watch?v=IG7NuH5QTdE
 (2:37)
 

Pain
  Mind
 &
 Body
 Effects
 
 

}  Lasts
 4
 hours
 to
 3
 days
 

}  Throbbing
 pain
 with
 
waves
 of
 greater
 pain
 

}  Light,
 sound,
 smells,
 or
 
motion
 can
 make
 pain
 
worse
 
◦  Mayo
 Clinic
 (2014)
 

}  Sight:
 things
 can
 look
 
fuzzy
 or
 foggy
 

}  Dizziness
 

}  Nausea,
 may
 throw
 up
 

}  Trouble
 thinking
 straight
 

◦  Mayo
 Clinic
 (2014)
 

}  Lasts
 1
 to
 2
 days
 after
 Attack
 ends
 
}  Feel
 worn
 out,
 mentally
 and
 physically
 exhausted
 
}  Can
 experience
 a
 bit
 of
 euphoria
 
◦  Biological
 -­‐
 not
 just
 glad
 it’s
 over
 

 
}  Mayo
 Clinic
 (2014)
 

}  Prodrome
 
◦  Left
 side
 of
 head
 feels
 different,
 sometimes
 tingles
 slightly
 
◦  Might
 stop
 migraine
 progression
 if
 I
 rest
 and
 avoid
 computers
 
◦  When
 neck
 is
 sore,
 the
 attack
 stage
 is
 usually
 bad
 

}  Aura
 
◦  Rare,
 but
 when
 I
 get
 them,
 left
 eye’s
 vision
 blurs.
 It’s
 more
 like
 an
 

angelic
 glow
 than
 an
 out-­‐of-­‐focus
 projector
 
}  Attack
 
◦  Pain
 thumps
 with
 my
 pulse,
 with
 pressure
 pain
 between
 beats
 
◦  Meanwhile,
 waves
 of
 stronger
 pain
 can
 hit
 with
 another
 rhythm
 
◦  Ranges
 from
 being
 difficult
 to
 walk/drive
 to
 debilitating
 

}  Postdrome
 
◦  Sensation
 of
 the
 attack
 breaking,
 like
 the
 crash
 of
 a
 wave
 releasing
 

its
 energy,
 and
 a
 surge
 of
 bliss
 
◦  Have
 no
 energy
 and
 can’t
 focus
 thoughts
 normally
 for
 1-­‐2
 days
 

}  First
 thought
 to
 be
 caused
 by
 constricting
 
blood
 vessels
 in
 the
 head
 (you
 may
 have
 
heard
 that)
 

}  Now
 thought
 to
 be
 genetic:
 a
 specific
 part
 
of
 nerves
 in
 the
 brain
 don’t
 have
 the
 
normal
 structure
 
◦  i.e.,
 it’s
 a
 neurological
 problem,
 not
 
circulatory
 

 
}  National
 Institute
 of
 Neurological
 Disorders
 and
 Stroke
 

(2014)
 

}  Irregular
 eating
 
schedule
 

}  Processed,
 salty
 food
 
}  Artificial
 sweeteners
 
}  Too
 much
 caffeine
 
}  Alcohol,
 esp.
 red
 wine
 
}  Glare
 from
 sun/lights
 
}  Shifting
 weather,
 i.e.
 
barometric
 pressure
 
changes,
 seasonal
 
transitions
 

}  Irregular
 sleep,
 daylight
 
savings
 time
 changes
 

}  Mental/physical
 stress
 
}  Menstrual
 cycle
 
}  Perfume/cologne
 
}  Smoke
 
}  TV/computer
 use
 

 

*These
 vary
 greatly
 
from
 person
 to
 person
 

 
}  Mayo
 Clinic
 (2014)
 

}  Associations
 between
 biopsychosocial
 factors
 and
 
migraines
 have
 been
 found
 in
 adults
 and
 minors
 

}  Some
 associations
 are
 different
 for
 people
 with
 
migraines
 than
 those
 with
 other
 types
 of
 headaches
 

}  Other
 associations
 are
 the
 same
 across
 headache
 
types
 

}  Full
 assessment
 using
 Sperry’s
 (2006)
 13
 key
 markers
 
is
 recommended,
 giving
 particular
 attention
 to
 the
 
factors
 on
 the
 following
 slides
 

}  Frequency:
 People
 with
 chronic,
 almost
 daily
 
headaches
 have
 greater
 psychological
 effects
 than
 
those
 with
 less
 frequent
 headaches
 (Mongini
 et
 al.,
 2006)
 

}  Anxiety
 &
 Depression:
 Those
 with
 headaches
 are
 
more
 likely
 to
 have
 anxiety
 or
 depression,
 which
 can
 
make
 headaches
 worse,
 and
 so
 on
 (Mongini
 et
 al.,
 2006)
 

}  Family
 History:
 People
 with
 headaches
 often
 have
 
family
 members
 with
 neuropsychiatric
 problems
 
(anxiety,
 headaches,
 etc.),
 which
 may
 involve
 the
 
same
 neurotransmitters
 as
 migraines
 (Margari
 et
 al.,
 2013)
 

}  Health-­‐Related
 Quality
 of
 Life:
 Lower,
 regardless
 of
 
frequency
 or
 strength
 of
 migraines
 (Raggi,
 et
 al.,
 2011)
 

}  Household
 Work:
 Often
 affected
 

◦  Personal
 hygiene,
 etc.
 usually
 not
 (Raggi,
 et
 al.,
 2011)
 
}  Social
 Activity:
 Often
 affected
 

◦  Getting
 along
 with
 others
 usually
 not
 (Raggi,
 et
 al.,
 2011)
 
}  Somatic
 Amplification:
 More
 likely
 to
 complain
 about
 
normal
 body
 sensations
 (Yavuz,
 et
 al.,
 2013)
 

}  Stress:
 More
 stress
 relates
 to
 more
 migraine
 disability
 
(Yavuz,
 et
 al.,
 2013)
 

}  Girls
 Internalize
 Symptoms:
 Boys
 with
 migraines
 and
 
children
 with
 other
 types
 of
 headaches
 don’t
 as
 often
 
(Kröner-­‐Herwig
 &
 Gassmann,
 2012)
 

}  Internalizing
 Anger:
 Worse,
 more
 frequent
 migraines
 
correlate
 with
 holding
 in
 anger
 and
 blaming
 themselves
 
for
 it
 (Tarantino
 et
 al.,
 2013)
 

}  Somatic
 Amplification
 (Kröner-­‐Herwig
 &
 Gassmann,
 2012)
 
}  School
 Stress
 &
 No
 Free
 Time:
 Make
 all
 types
 of
 
headaches
 worse
 
◦  Lack
 of
 physical
 activity
 &
 homework
 amounts
 do
 not
 
correlate
 with
 headaches
 (Kröner-­‐Herwig
 &
 Gassmann,
 2012)
 

}  If
 using
 tests
 to
 assess,
 consider
 giving
 both:
 
◦  WHO
 Disability
 Schedule
 II
 (WHO-­‐DAS-­‐II)
 
◦  Migraine
 Disability
 Assessment
 Questionnaire
 
(MIDAS)
 

}  Complimentary
 Limitations:
 The
 results
 of
 one
 give
 
insight
 into
 the
 results
 of
 the
 other
 

}  Biopsychosocial
 aspects
 are
 covered
 

 

}  Raggi
 et
 al.
 (2011)
 
 
 

}  Over-­‐the-­‐counter
 pain
 medications,
 NSAIDs
 
}  Triptans
 
◦  Sumatriptan
 (Imitrex)
 manages
 my
 Attack
 pain
 but
 not
 other
 
symptoms
 
◦  Can
 cause
 rebound
 migraine
 after
 it
 wears
 off,
 basically
 meaning
 
the
 migraine
 lasts
 twice
 as
 long
 
◦  Must
 be
 taken
 before
 Attack
 stage
 to
 be
 fully
 effective
 

}  Anti-­‐depressants
 
}  Botox
 
}  Others
 are
 used
 too,
 depending
 on
 the
 case
 

}  Mayo
 Clinic
 (2014)
 

}  Taking
 medication
 regularly
 to
 prevent
 migraines
 
}  Works
 as
 well
 as
 psychosocial
 treatments
 like
 CBT,
 
biofeedback,
 and
 relaxation
 (Buse
 &
 Andrasik,
 2009)
 

}  Used
 for
 frequent
 and/or
 very
 severe
 migraines
 once
 
psychosocial
 treatments
 have
 failed
 to
 work
 for
 a
 
patient
 (Termine
 et
 al.,
 2011)
 

}  Research
 has
 shown
 these
 to
 work,
 but
 they
 may
 
have
 side-­‐effects:
 
◦  Flunarizine
 
◦  Cyproheptadine
 
◦  Amitriptyline
 
◦  Divalproex
 sodium
 
◦  Topiramate
 

}  Termine
 et
 al.
 (2011)
 

}  Taking
 supplements
 may
 decrease
 migraines:
 
◦  Riboflavin
 (B2)
 
◦  Coenzyme
 10
 (CoQ-­‐10)
 
◦  Magnesium
 
�  Methotrexate
 depletes
 magnesium,
 so
 I
 take
 this
 to
 avoid
 
migraines
 from
 having
 too
 little.
 Magnesium
 levels
 fluctuate
 
daily
 and
 are
 almost
 never
 checked
 with
 a
 blood
 test
 

}  Mayo
 Clinic
 (2014)
 

 

}  According
 to
 the
 National
 Center
 for
 Biotechnology
 
Information
 (2014),
 part
 of
 the
 NIH,
 maybe
 

}  Transcranial
 Magnetic
 Stimulation
 (TMH)
 
◦  Better
 than
 placebo
 in
 studies
 
◦  In
 some,
 reduces
 how
 often
 migraines
 hit
 or
 how
 bad
 
they
 are
 

}  No
 information
 yet
 on
 long-­‐term
 effects,
 good
 or
 bad
 

}  Learning
 to
 control
 automatic
 functions
 through
 
relaxation,
 focus,
 visualization,
 and/or
 breathing
 

}  Requires
 patient
 training
 and
 practice
 (Buse
 &
 Andrasik,
 2009)
 
}  Most
 effective
 types
 for
 migraine
 prevention
 (Buse
 &
 

Andrasik,
 2009):
 
◦  Thermal:
 Usually
 controlling
 finger
 temperature;
 a
 warmer
 
finger
 means
 the
 patient
 is
 more
 relaxed
 
◦  Electromyographic:
 Controlling
 muscle
 tension
 

}  Helps
 older
 children
 and
 adults
 (Termine
 et
 al.,
 2011)
 
}  Some
 research
 conflicts,
 saying
 it’s
 not
 better
 than
 
placebo
 (sham)
 treatments
 (Autret,
 Valade,
 &
 Debiais,
 2012)
 

}  Broad
 treatment
 category,
 includes
 Progressive
 
Muscle
 Relaxation
 Training
 (flexing
 &
 relaxing
 
muscles),
 visualization,
 yoga,
 and
 hypnosis
 

}  Should
 be
 paired
 with
 biofeedback;
 they
 enhance
 
each
 other
 and
 are
 less
 effective
 when
 used
 alone
 

}  Buse
 &
 Andrasik
 (2009)
 

}  Helps
 prevent
 migraines
 by
 teaching
 patients
 how
 
to
 control
 migraine
 triggers
 and
 reduce
 harmful
 
responses
 like
 hopelessness
 and
 anxiety
 

}  Patients
 often
 keep
 a
 migraine
 diary
 to
 identify
 
triggers
 and
 stressors
 

}  Attempts
 to
 improve
 patient’s
 quality
 of
 life
 and
 
migraines,
 since
 they
 affect
 each
 other
 

}  See
 the
 Association
 for
 Behavioral
 and
 Cognitive
 
Therapies
 at
 www.abct.org
 

}  Buse
 &
 Andrasik
 (2009)
 

}  When
 patients
 understand
 what
 migraines
 are
 and
 
how
 treatments
 work,
 they
 do
 better
 in
 every
 way
 

}  Teach
 over
 time
 and
 review
 previous
 info
 
}  Focus
 on
 what’s
 most
 important
 and
 keep
 it
 simple:
 
◦  Migraines
 hurt
 but
 don’t
 damage;
 it’s
 only
 pain
 
◦  The
 4
 Stages:
 What
 are
 they?
 (see
 slide
 5
 to
 cheat)
 
◦  Triggers
 
◦  How
 medications
 work,
 when
 to
 take
 them,
 and
 
interactions
 to
 avoid
 

}  For
 child
 and
 adult
 patients,
 educate
 the
 family
 too
 

}  Buse
 &
 Andrasik
 (2009)
 

}  Acupuncture:
 Can
 help
 tension
 headaches
 but
 
does
 not
 help
 migraines
 (Autret,
 Valade,
 &
 Debiais,
 2012)
 

 
}  Stress
 Management:
 Sometimes
 discussed
 as
 a
 
unique
 treatment,
 it
 is
 a
 key
 component
 of
 
biofeedback
 and
 CBT.
 It
 should
 be
 part
 of
 any
 
migraine
 treatment
 for
 adults
 or
 children
 (Termine
 et
 
al.,
 2011)
 

}  Research
 says
 these
 determine
 outcomes
 (Autret,
 Valade,
 &
 
Debiais,
 2012):
 
◦  The
 patient’s
 understanding
 of
 migraines
 and
 expectations
 
◦  Conditioned
 responses
 to
 treatments
 through
 practice
 
◦  Physical
 contact
 
◦  Addressing
 migraines
 on
 the
 biological
 level
 
◦  Treating
 other
 mental
 conditions
 present,
 like
 depression
 
◦  Support
 from
 others
 
◦  Education
 from
 medical
 staff
 

 

}  Beware:
 Adults
 and
 children
 might
 overmedicate
 (Termine
 
et
 al.,
 2011)
 

Assessment
 and
 treatment
 
“algorithm”
 for
 migraine
 
management
 (Termine
 et
 al.,
 2011,
 
figure
 1)
 

A Migraine Model

}  Clinicians
 Should:
 Take
 the
 time
 to
 fully
 assess
 the
 
patient,
 monitor
 patient
 progress,
 give
 written
 and
 
spoken
 directions,
 and
 involve
 the
 family
 

}  Teach
 the
 Patients:
 How
 treatments
 work,
 how
 to
 
change
 lifestyles,
 and
 tools
 for
 self-­‐management.
 Use
 
written
 materials
 

}  Involve
 the
 Patients:
 Plan
 together,
 give
 them
 control
 
and
 congratulate
 them
 when
 they
 succeed
 

 
}  Rains,
 Lipchik,
 &
 Penzien
 (2006),
 as
 cited
 by
 Buse
 &
 Andrasik
 (2009)
 

}  Mayo
 Clinic
 
◦  http://www.mayoclinic.org/diseases-­‐conditions/migraine-­‐
headache/basics/definition/con-­‐20026358
 

}  Migraine
 Research
 Foundation
 
◦  http://www.migraineresearchfoundation.org
 

}  American
 Headache
 Society
 
◦  http://www.achenet.org
 

}  National
 Headache
 Foundation
 
◦  http://www.headaches.org
 

}  Migraine
 Headaches
 Support
 Group
 (an
 active
 forum)
 
◦  http://www.mdjunction.com/forums/migraine-­‐headaches-­‐
discussions
 

ABC
 News
 (2011).
 Reporter
 Serene
 Branson:
 Not
 a
 stroke
 just
 a
 migraine
 (02.18.11)
 [television
 
broadcast].
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