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May 2003, Volume 33 Number 5 , p 32cc4 - 32cc6





  • Abstract

  • Oh, my aching head

  • Assessing your patient

  • Treating migraine

  • Taking charge

  • Fast facts about migraine

  • Tailoring migraine treatment

  • Mild symptoms

  • Moderate to severe symptoms

  • Headache accompanied by nausea



  • Source

  • Abstract

    Help relieve your patient's pain and teach her how to prevent or minimize future flare-ups.

    Migraine affects nearly 28 million Americans, mostly women. Yet according to experts, migraine is underdiagnosed and undertreated. Many patients come to the emergency department (ED) with headache pain that's already out of control. In this article, I'll describe migraine pathophysiology and treatment and discuss how you can help your patient prevent and treat flare-ups.

    Oh, my aching head

    Migraine is a complex event, not just the result of vasodilation. A triggering event sets off a cascade of neurotransmitter releases, including calcitonin-gene-related peptide, neurokinin A, and substance P. These activate serotonin receptors, causing a sterile inflammation of the surrounding trigeminal neurons and vasodilation. Eventually, pain sensations arise from stimulation of the thalamus and trigeminal nucleus caudalis. Autonomic stimulation causes nausea and vomiting, and involvement of the occipital area is thought to cause photophobia and phonophobia.

    Migraines can be triggered by physical and emotional stressors. Physical triggers include illness, too little or too much sleep, missing meals, bright or flickering lights, strong odors, weather or seasonal changes, and hormonal changes, particularly sudden drops in estrogen. Foods may also trigger migraine, although patients may overestimate food's role in causing ...

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