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NR603 Week 1 Quiz Study Guide
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NR603 Week 1 Quiz Study Guide• Migraine: Assessment
• It is important that the patient characterize the headache by describing the duration, quality, and location of the
pain.
• A medication profile is essential and should include medications that have been tried in the past for headache
control. If OTC medications are taken, the number used per month should be identified
• A targeted physical examination is important in ruling out harmful secondary headache pathologies and confirms
any information given in the history.
• The examination findings in primary headache disorders are usually within normal limits.
• Key aspects of the physical examination include a cardiopulmonary and complete neurologic assessment
with a major focus on the following:
· • Funduscopic and pupillary assessment
· • Auscultation of the carotid and vertebral arteries
· • Mental status examination
· • Palpation of the head, neck, and temporal arteries
· • Evaluation for any neck stiffness, focal weakness, sensory loss and gait
· • Vital signs
• Problem findings include:
· Onset of headache after the age of 50 years
· Asymmetry of pupillary responses
· Decreased deep tendon reflexes
· Headache described as “the worst ever experienced”
· Personality change
· Onset of a new or different headache
· Onset of a headache that progressively worsens
· Papilledema
· Painful temporal arteries
• Diagnosis
· If the diagnosis is not clear or the history or physical findings are cause for concern, diagnostic studies
should be used to distinguish primary headache from a secondary condition.
· Blood tests are usually not indicated, may include a complete blood count (CBC) to exclude anemia or an
infectious process, (ESR) or (CRP) to help exclude temporal arteritis, and thyroid function tests to identify
thyroid dysfunction.
· Lyme titer or rheumatoid factors may also be indicated in some situations.
• Practice guidelines
· Advocate three principles for diagnostic testing:
▪ (1) testing should be avoided if it will not change the management of the patient,
▪ (2) testing is not indicated if the patient is not significantly more likely than the general public to
have an abnormality
▪ (3) testing may make sense in a patient who is excessively concerned that he or she has a serious
problem that is causing the headaches.
· Neuroimaging should be considered when any serious signs or symptoms are present but it is not indicated
if the patient has had these headaches for years, if there are no focal neurologic signs, and if the headache
improves without the use of analgesics.
• Treatment
· Nonpharmacological measures
▪ behavior modification, biofeedback, acupressure, management of headache triggers, and a wellness
program.
· Preventive therapy is appropriate for patients if they are unable to deal with their attacks, they experience
more than four headaches a month, or the attacks are prolonged and refractory to medicine.
▪ Preventive therapy is given daily and will decrease headache intensity and frequency
▪ A connection has been shown between epilepsy and migraine; therefore anticonvulsants, such as
divalproex sodium (Depakote), gabapentin (Neurontin), and topiramate (Topamax), can be used
▪ A patient with cold hands, Raynaud phenomenon, or hypertension may do well with calcium
channel blockers, such as diltiazem (Cardizem) and amlodipine (Norvasc), which cause vasodilation
, NR603 Week 1 Quiz Study Guide
and decrease blood pressure.
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