Capstone Migraine
5
Synopsis of Migraine Management FNP Approach Paper
The Introduction
Migraine is a complex condition that affects the central nervous system, and among Black women in the United States, the condition disproportionately affects women between 18 and 50 years. Biological, cultural, and social determinants of health in a place like Plainfield, Illinois, worsen the health disparities because migraines go unnoticed and untreated. Systemic inequalities like racism, health care distrust, lack of access to specialists, and the lack of cultural competence among medical workers also aggravate such inequalities. FNP is the only profession to annul these gaps because the profession promotes patient-centric diligence that encompasses evidence-based procedures and culturally competent interventions. In this paper, pathophysiology, epidemiology, diagnosis, prevention, pharmacological treatment, patient education, and interprofessional collaboration are discussed as the mechanisms required to facilitate equal migraine care. It will emphasize the importance of FNPs in addressing the healthcare outcomes in Black women with migraine conditions and the importance of incorporating culturally sensitive treatment methods in order to limit health disparities.
The PICO Statement
The following PICO statement outlines the focus of the paper:
· Population (P): Black women between the ages of 18 and 50 years living in the locality of Plainfield, Illinois, with a disadvantaged and underserved population with contributive factors of systemic disparities and social determinants of health, who are experiencing migraines.
· Intervention (I): A holistic and culturally competent process of migraine management robust through Family Nurse Practitioners (FNPs), including the biology, psychology, social, and spiritual domains using prevention, pharmacologic treatments, educational training, and interprofessional collaboration practices based on the Shuler Nurse Practitioner Practice Model.
· Comparison (C): The typical care of migraine without the inclusion of patient-centeredness and cultural competence, as well as integration of the Shuler Model.
· Outcome (O): Improved migraine control, healthcare disparity, better quality of life, and more adherence to treatment among the people
Literature Review
Evidence has underscored sizeable disparities between the diagnosis and treatment of migraine among Black women, which is catalyzed primarily by institutionalized racism, implicit bias, and socioeconomic disparities. Such reasons lead to low diagnosis and inadequate treatment, and cultural stigma, health system mistrust, and lack of access to exceptional care are the specific challenges of Black women (Burch et al., 2021; Kiarashi et al., 2021; VanderPluym et al., 2022). Such health disparities might be decreased through structural modification, (Kiarashi et al. 2021), and cultural competence and medical professional education that improve access to care and its quality (VanderPluym et al., 2022).
Migraine can be discussed in terms of the pathophysiology of the disease, which relates it to the aspects of cortical spreading depression, trigeminovascular activation, and the liberation of such neuropeptides as CGRP, substance P, and neurokinin A that all are factors that add to the experiencing of the pain and neurological effects of migraine (Ailani et al., 2021; Khan et al., 2021; Puledda et al., 2023). Migraines can also be triggered by genetic predispositions combined with stress factors, hormonal changes, days with sleep disturbance, etc., and those with familial hemiplegic migraines have some ion channel mutations that reduce the threshold at which migraines occur (Khan et al., 2021).
Epidemiologically, the number of people with migraine is estimated to be 39 million in America, with more women than men prone to migraine. This situation is even worse among Black women, where the number of those with chronic migraines has been more evident, as well as a high divide in the treatment among African Americans and their white counterparts (Dong et al., 2025; Burch et al., 2021). Cultural stigma and a low level of services provided with cultural competence contribute to the insufficient diagnosis of the underlying migraines in the group, which is why building an early screening and placing culturally competent care in the discussion of interactions with patients is critical to said problem (Kiarashi et al., 2021).
The medications used in efficient treatment are triptans and CGRP medications, with non-pharmacologic ones like lifestyle changes, stress management, and food changes (Ailani et al., 2021; Callen et al., 2024). FNPs also play a critical role in the promotion of pharmacological interventions and non-pharmacological interventions, and addressing these disparities through the use of patient education and interprofessional collaboration (Cook et al., 2025).
Conclusion
To summarize, there are severe gaps in the healthcare delivery of migraines among Black women because of structural and cultural influences of the problem. The information indicates that it is necessary to introduce culturally competent and patient-centered care in order to achieve better results. The Shuler Nurse Practitioner Model provides a well-developed model in dealing with the mentioned challenges based on the needs of patients, which can be split into biological, psychological, social, and spiritual. As challenging health disparities or issues demand, FNPs are in the best position to initiate successful attempts to improve the way of handling migraines by diagnosing them at an early stage, through evidence-based interventions, and through interprofessional relationships. The quality of care provided to Black women with migraines would improve by ensuring future research and training of providers on cultural competence in order to reduce such health disparities.
References
Ailani, J., Burch, R. C., Robbins, M. S., & Board of Directors of the American Headache Society. (2021). The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache: The Journal of Head and Face Pain, 61(7), 1021–1039. https://doi.org/10.1111/head.14153
Burch, R., Rizzoli, P., & Loder, E. (2021). The prevalence and impact of migraine and severe headache in the United States: updated age, sex, and socioeconomic‐specific estimates from government health surveys. Headache: The Journal of Head and Face Pain, 61(1), 60-68. https://doi.org/10.1111/head.14024
Callen, E., Clay, T., Alai, J., Crawford, P., Visconti, A., Nederveld, A., ... & Jabbarpour, Y. (2024). Migraine care practices in primary care: results from a national US survey. Family Practice, 41(3), 277–282. https://medicine.uky.edu/sites/default/files/2024-05/Migraine%20Care%20Practices%20in%20Primary%20Care.pdf
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Puledda, F., Silva, E. M., Suwanlaong, K., & Goadsby, P. J. (2023). Migraine: from pathophysiology to treatment. Journal of Neurology, 270(7), 3654-3666. https://link.springer.com/content/pdf/10.1007/s00415-023-11706-1.pdf
Shuler, P. A., & Davis, J. E. (2020). The Shuler nurse practitioner practice model: a theoretical framework for nurse practitioner clinicians, educators, and researchers, part 1. Journal of the American Academy of Nurse Practitioners, 5(1), 11–18. https://doi.org/10.1111/j.1745-7599.1993.tb00835.x
VanderPluym, J. H., Charleston IV, L., Stitzer, M. E., Flippen, C. C., Armand, C. E., & Kiarashi, J. (2022). A review of underserved and vulnerable populations in headache medicine in the United States: challenges and opportunities. Current pain and headache reports, 26(6), 415–422. https://doi.org/10.1007/s11916-022-01042-w