illness powerpoint assignment
Cheyla26
SAMPLEPresentation-MigraineHeadaches.pdf
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]. Retrieved from http://www.youtube.com/watch?v=IG7NuH5QTdE
Autret, A., Valade, D., & Debiais, S. (2012). Placebo and other psychological interactions in headache treatment. The Journal of Headache and Pain, 13(3), 191-‐198. doi:10.1007/ s10194-‐012-‐0422-‐0
Buse, D. C., & Andrasik, F. (2009). Behavioral medicine for migraine. Neurologic Clinics, 27(2), 445-‐465. doi:10.1016/j.ncl.2009.01.003
Cutrer, F. M. [Mayo Clinic]. (2011). Dr. Cutrer (3) -‐ 4 types of migraine auras [online video]. Retrieved from http://www.youtube.com/watch?v=ML1ZIk5v_C4
Kröner-‐Herwig, B., & Gassmann, J. (2012). Headache disorders in children and adolescents: Their association with psychological, behavioral, and socio-‐environmental factors. Headache: The Journal of Head and Face Pain, 52(9), 1387-‐1401. doi:10.1111/j. 1526-‐4610.2012.02210.x
Margari, F., Lucarelli, E., Craig, F., Petruzzelli, M. G., Lecce, P. A., & Margari, L. (2013). Psychopathology in children and adolescents with primary headaches: Categorical and dimensional approaches. Cephalalgia, 33(16), 1311-‐1318. doi:10.1177/0333102413495966
Mayo Clinic. (2014). Migraines. Retrieved from http://www.mayoclinic.org/diseases-‐conditions/ migraine-‐headache/basics/definition/con-‐20026358
Mongini, F., Rota, E., Deregibus, A., Ferrero, L., Migliaretti, G., Cavallo, F., . . . Novello, A. (2006). Accompanying symptoms and psychiatric comorbidity in migraine and tension-‐type headache patients. Journal of Psychosomatic Research, 61(4), 447-‐451. doi:10.1016/ j.jpsychores.2006.03.005
National Center for Biotechnology Information. (2014). NICE approves migraine magnet therapy. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/ news/2014-‐01-‐22-‐nice-‐approves-‐migraine-‐magnet-‐therapy/
National Institute of Neurological Disorders and Stroke. (2014). NINDS migraine information page. Retrieved from http://www.ninds.nih.gov/disorders/migraine/migraine.htm
Raggi, A., Leonardi, M., Bussone, G., & D’Amico, D. (2011). Value and utility of disease-‐specific and generic instruments for assessing disability in patients with migraine, and their relationships with health-‐related quality of life. Neurological Sciences, 32(3), 387-‐392. doi: 10.1007/s10072-‐010-‐0466-‐3
Sperry, L. (2006). Psychological treatment of chronic illness: The biopsychosocial therapy approach. Washington, DC: American Psychological Association.
Tarantino, S., De Ranieri, C., Dionisi, C., Citti, M., Capuano, A., Galli, F., . . . Valeriani, M. (2013). Clinical features, anger management and anxiety: A possible correlation in migraine children. The Journal of Headache and Pain, 14(39), 1-‐8. doi:10.1186/1129-‐2377-‐14-‐39
Termine, C., Özge, A., Antonaci, F., Natriashvili, S., Guidetti, V., & Wöber-‐Bingöl, Ç. (2011). Overview of diagnosis and management of paediatric headache. part II: Therapeutic management. The Journal of Headache and Pain, 12(1), 25-‐34. doi:10.1007/ s10194-‐010-‐0256-‐6
Yavuz, B. G., Aydinlar, E. I., Dikmen, P. Y., & Incesu, C. (2013). Association between somatic amplification, anxiety, depression, stress and migraine. The Journal of Headache and Pain, 14(53), 1-‐6. doi:10.1186/1129-‐2377-‐14-‐53
