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1.2 HEADACHE SYNDROME : B) MIGRAINE - Coggle Diagram
1.2 HEADACHE SYNDROME : B) MIGRAINE
A) DEFINITION
Headache w characteristics of pulsative sensation, nausea and vomiting, phobia to light and sound and occur for hrs to day that disrupt daily activities
B) ETIOLOGY
Genetics
Stress
Food & drinks
Chocolate
Wine
Cheese
Hormonal changes: Serotonin
C) PATHOPHYSIOLOGY
:arrow_down: Serotonin
Stimulate vasodilation & :arrow_up: permeability of blood vessels in brain
Trigeminal nerve receptor detect this condtion and transmit the information to cerebral cortex aka sensory cortex
Sensory cortex perceived the infomation as
PAIN
Cortical stress depression
Create
AURA
- present b4 actual migraine
Scotoma present - blindspot
Due to a part of brain become
HYPEREXCITABILITY
:arrow_right: spread to cerebral cortex
Cerebral cortex perceive as pain :arrow_right: stimulate pain receptor - Trigeminal nerve
Pain receptor stimulate proteins to release
Induce mast cells secrete histamine causing inflammation
Induce vasodilationb & :arrow_up: permeability
Trigeminal nere detect this send infomation to cerebral cortex
Cerebral cortex perceive the info as pain
D) CM
(P.O.U.N.D)
Pulsatile
One day duration
Unilateral
Nausea/ Vomit
Disabling
MAY OR NOT PRESENT AURA' S
- Certain part of brain cause diff aura
Visual abnormalitiis - Scotoma
Sensory abnormalities - Parethesia
Motor abnormalities - Weakness
Brain stem aura's
Diplopia - Double vision
Vertigo
:arrow_down: hearing
Dysarthia
Retinal aura's
Hemiplegic Migraine - Unilateral weakness of motor ; occur at least for 72 hours
Photophobia & phonophobia
E) DIFF Dx
Stroke
Cerebral aneurysm
Encephalitis
Meningitis
Tension headache
F) Ix
Radiology
Cerebral CT, MRI and X ray - Identify any abnormalities of brain func & structure
Lab
Full blood count - :arrow_up: wbc if infection
BUSE - Measure electrolyte level
CSF culture & sensitivity- identify specific bacteria and antibiotic works to the bacteria
PCR - identify virus
IP
Lumbar puncture - Procedure where pt lie lateral to take CSF sample using needle
G) Mx
Medical
Hx taking - nutrition, social hx, family hx
Survey I/O chart - Ensure balance electrolyte since pt vomitted
IV NS 0.9%
Take vital sign - HR, BP, BT, RR, SPO2
Physical examination - Neuro examination on cranial nerves, motor system
Pharmacology
Antiemetics - Tab Metoclopramide HCL 10 mg
A; Tab Metoclopramide 10 mg tds 5/7
C: Tab Metoclopramide 0.5 mg/ kg 5/7
NSAIDS - Ketoralac
A: IV Ketoralac 30 mg OD
:arrow_up: Serotonin (Triptan): Sumatriptan
50 mg / attack ; not more 300 mg daily
Corticosteroids: Dexamethasone
Inj Dexamethasone 20 mg OD not more than 80 mg
Beta blocker: propranolol
Tab Propranolol 40 mg tds
Anticonvulsant: Sodium valproate
A: Tab Sodium Valproate 600 mg in 3 divided dose
C > 20 KG: Tab Sodium Valproate 30 mg /kg / day
C < 20 kg: Tab Sodium Valproate 20 mg/kg/ day
Nursing care
Survey I/O chart and vital sign
Provide diet not trigger migraine
Ensure pt rest in comfortable pt
Assist pt w NG tube if pt not able to eat
Mandi lap pt sekiranya pt have muscle weakness
H) HE
Home
Rest in dark & quiet room
Avoid stress
Avoid food triggers migraine
Follow up for futher assestment & treatment
Hospital
Rest in dark & quiet room
Seek help for caunseling for social factors that induce stress
I) COMPLICATION
Hemipghletic migraine
Depression
Difficulty in concentrate
Migraine aura triggered seizure