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December 2002, Volume 32 Number 12 , p 76 - 77





  • More than a headache

  • Treating a migraine

  • Put your finger on the trigger

  • How do I know it's a migraine?



  • QUESTION: My patient came to the ED for severe migraine pain that hadn't been relieved by over-the-counter (OTC) medication. Why would she wait so long to get help?

    ANSWER: Many patients try to cope on their own until they can't control the pain with OTC medications. They also can become weary of repeated episodes or start to worry about a serious disorder, such as a brain tumor. What most patients don't know is this: OTC medications may actually worsen migraine pain by causing a rebound headache. By teaching your patient to recognize early symptoms of a migraine and treat it appropriately, you can help her avoid another visit to the ED.

    More than a headache

    Migraine affects nearly 28 million Americans, mostly women. Less than one-half of these sufferers are properly treated. No medical test exists for diagnosing migraine, but you can assess the condition by asking your patient the following questions:

    * What are the onset, location, duration, characteristics, aggravating factors, associated symptoms, relieving factors, and treatment to date of your headache?

    * What other symptoms precede (such as an aura) and accompany your headache, such as phonophobia or photophobia?

    * What is your medical history? Also, what is your cardiovascular history? (Some drugs used to treat migraines have serious cardiovascular adverse effects.)

    * What OTC medications are you taking? Are you using any herbs or alternative therapies?

    * What triggers your migraine attacks? For example, do certain smells, foods, hunger, or your menstrual period trigger an attack?

    After asking these questions, perform a physical assessment. Then compare your ...

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