NR 603 WEEK 1 STUDY GUIDE:Migraine Assessment|Chamberlain College of Nursing

NR 603 WEEK 1 STUDY GUIDE:Migraine Assessment|Chamberlain College of Nursing

·         Migraine: Assessment

·         It is important that the patient characterize the headache by describing the duration, quality, and location of the pain.

·         A medication profile is essential and should include medications that have been tried in the past for headache control. If OTC medications are taken, the number used per month should be identified

·         A targeted physical examination is important in ruling out harmful secondary headache pathologies and confirms any information given in the history.

·         The examination findings in primary headache disorders are usually within normal limits.

·         Key aspects of the physical examination include a cardiopulmonary and complete neurologic assessment with a major focus on the following:

·          • Funduscopic and pupillary assessment

·          • Auscultation of the carotid and vertebral arteries

·          • Mental status examination

·          • Palpation of the head, neck, and temporal arteries

·          • Evaluation for any neck stiffness, focal weakness, sensory loss and gait

·          • Vital signs

·         Problem findings include: 

·          Onset of headache after the age of 50 years

·          Asymmetry of pupillary responses

·          Decreased deep tendon reflexes

·          Headache described as “the worst ever experienced”

·          Personality change

·          Onset of a new or different headache

·          Onset of a headache that progressively worsens

·          Papilledema

·          Painful temporal arteries

·         Diagnosis

·          If the diagnosis is not clear or the history or physical findings are cause for concern, diagnostic studies should be used to distinguish primary headache from a secondary condition.

·          Blood tests are usually not indicated, may include a complete blood count (CBC) to exclude anemia or an infectious process, (ESR) or (CRP) to help exclude temporal arteritis, and thyroid function tests to identify thyroid dysfunction.

·          Lyme titer or rheumatoid factors may also be indicated in some situations.

·         Practice guidelines

·          Advocate three principles for diagnostic testing:

§  (1) testing should be avoided if it will not change the management of the patient,

§  (2) testing is not indicated if the patient is not significantly more likely than the general public to have an abnormality

§  (3) testing may make sense in a patient who is excessively concerned that he or she has a serious problem that is causing the headaches.

·          Neuroimaging should be considered when any serious signs or symptoms are present but it is not indicated if the patient has had these headaches for years, if there are no focal neurologic signs, and if the headache improves without the use of analgesics.