r. nial bradshaw / flickr creative commons
This month’s CE feature article, Diagnosing and Managing Migraine, is one I’m sure many readers will relate to, and perhaps even find some answers in for their own headaches.
Like many women, I could count on experiencing at least one each month—classic menstrual migraines—that would begin with a visual aura of wavy lines that made reading or driving impossible. Sometimes, taking acetaminophen or ibuprofen right at the onset of the aura and relaxing/lying down, could prevent it from progressing further.
Otherwise, I would become overly sensitive to lights and sounds and develop a pounding headache and nausea that made me retreat to a dark, quiet room for several hours until the headache passed.
The most debilitating type of primary headache.
The authors note that “90% of the U.S. population will develop a headache within their lifetime.” Migraine, the most debilitating type of primary headache (that is, when the headache is the disorder as opposed to being secondary to other causes), occurs in about 12% of the population. I was surprised that while prevalence is fairly equally distributed among boys and girls prior until puberty (2.5 or 2.4 percent), it changes dramatically post-puberty:
“The greatest difference between the sexes occurred between the ages of 20 and 40, when migraine prevalence was 1.5 to 2.9 times higher in women than in men. After age 42, the prevalence remained twice as high in women as in men.”
A comprehensive clinical review for nurses.
The article is a comprehensive clinical review and includes a review of treatment and medications as well as prophylactic measures and patient education to anticipate and forestall a migraine headache. There’s also a section on pediatric migraine, which can manifest as abdominal pain—underscoring how difficult diagnosis can be.
You can read this article for free—and earn CE credit. This article was part of a series we published by authors from the University of Texas Southwestern Medical Center in Dallas. The other articles, Hypertensive Emergences: A Review in the October issue, and Acute Ischemic Stroke in the September issue, are also free to read and offer CE credit.
We’re a family of migraineurs, but oddly, each finds relief from only one thing, none of which helps anybody else. Dad was a Fiorinal guy; Mom did an ergot preparation. I went through almost everything known to medicine before finally settling on a 2nd-generation triptan (not covered by insurance until I saw a neurologist; I apologized to him but there was nothing else I could do). Daughter does 3-gen triptan, son does ok with acetaminophen. Mostly gone post menopause, but not entirely. Fortunately, I found that I could get $2000 worth of tasty dissolvable zolmatriptan for $550 in Mexico, so I would fill up on vacations or if friends went (and never travel without it). I also get optical migraines, in which my visual field gradually fills up with rather pretty lights, like looking at sun-bathed ripples on the surface of a pond from underwater. Completely painless and I kind of enjoy them, though I can’t do anything requiring vision until they go away in about half an hour.