Family Nurse Practitioner Case Study: Headaches

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Introduction

The case of the woman with regular migraines requires a thorough analysis for the proper planning of care. It should be based on laboratory test results and other clinical findings and involve the prescription of over-the-counter (OTC) medications in the first place. Consequently, the patient’s concerns regarding the implemented measures should be adequately addressed by the hospital employees, and sufficient information on triptan agents, ergotamine, and alternative treatment methods should be provided. The above approach seems complex and can be implemented only after gathering comprehensive data related to the woman, her medical history, and the recent changes in her condition.

Required Additional Information for Planning Treatment

The first aspect of the matter is the type of information necessary for rendering healthcare services to S.D. First, it is critical to conduct a series of tests, including urinalysis, CT scan, MRI, sinus x-ray, eye exam, and spinal tap, among the others (Bhargava, 2020). They are required to establish the correlation with other medical conditions, which might lead to the described issue. Second, the doctors should analyze the potential causes, which can be related to foods, medications, or stressful situations, to eliminate the risks connected to these factors (Bhargava, 2020). Third, they should identify the location of pain, its nature, whether it is a single or multiple types, and the severity on a scale from one to ten to determine which problem corresponds to it (Bhargava, 2020). In this way, the data encompasses clinical tests, causes, and accompanying circumstances.

Type of Headache

As follows from the case study, the type of headache experienced by S.D. can be determined by considering the provided details in the course of the initial examination. The reported symptoms correspond to the primary issue and, more specifically, moderate to severe migraine due to a number of factors. First, the presence of light-headedness and occasional flashes of light are the explicit signs of this condition (Schwedt & Garza, 2021). Second, the recurrent nature of the disease correlates with the above provision (Schwedt & Garza, 2021). Third, the absence of other symptoms, which can potentially indicate the existence of other health problems resulting in headaches, contributes to this conclusion (Schwedt & Garza, 2021). Thus, these three circumstances prove that the described stance is correct, and additional tests should be focused on these data.

Recommended OTC Treatment Options

In this situation, OTC treatment options are the first medications, which should be selected for assisting the woman in coping with the pain. They are helpful when the attack began while being useless for preventive purposes and in the case of severe migraines and, therefore, should not be completely relied on (Seladi-Schulman, 2021). First, Ibuprofen and Naproxen provide pain relief but do not eliminate it and are not suitable for everyone; however, they are an appropriate solution at the beginning (Seladi-Schulman, 2021). Second, S.D. can benefit from paracetamol or its combination with aspirin and caffeine, which are also first-line options (Seladi-Schulman, 2021). If the above suggestions do not help, other medications should be proposed to the patient.

Response to the Patient’s Concerns

The patient’s concerns regarding the increased tolerance to Imitrex are valid and, therefore, should be adequately addressed. Healthcare workers should inform S.D. about the possibility of readjusting treatment by suggesting alternative therapy. However, it should be noted that this decision can be made if the headaches become more frequent, more specifically, about eight events a month (Ha & Gonzalez, 2019). As can be seen from the case, only one such issue a week has been reported, which is insufficient for introducing long-term measures. In this situation, the change of the medicine to any of the above OTC options can be optimal for coping with pain, and further shifts will be made in accordance with their effects.

Tolerance and Triptan Agents

The particular attention of medical specialists should be paid to the matter of tolerance, especially when it comes to the triptan agents. This need is determined by the fact that some of the medication might be unsuitable for patients, which is revealed in the course of the treatment. Nevertheless, it is vital to understand that the possibility of adverse outcomes and their nature differs depending on the adopted solutions. Thus, for example, eletriptan or oral sumatriptan were reported to cause no problems of such nature, whereas subcutaneous sumatriptan sometimes requires lowering the dose to ensure safety (Schwedt & Garza, 2021). Hence, S.D. should be aware of the varying influence of different medications, which should be viewed separately and not as a combination of drugs with similar therapeutic properties.

Change for Acute Relief of Migraines

If the above negative impact related to the use of triptans for acute relief of the patient’s migraines is accompanied by the problems related to tolerance, they should be changed. In order to do this, specialists should consider the type of issue deriving from the previously adopted medications to avoid prescribing triptans with the same possible results. For instance, if S.D. is intolerant to triptans causing weakness, they should be avoided (Schwedt & Garza, 2021). In addition, it is important to consider suggesting a combination of medications, such as triptans with nonsteroidal anti-inflammatory drugs, which proved to be more effective than their separate use (Schwedt & Garza, 2021). In this way, the choice of other means should be made with respect to their effects and the comparison of previously adopted medications with new prescriptions.

Ergotamine and Its Role in Treating Migraines

The selection of ergotamine for treating migraines of S.D. is also possible, but it is vital to understand the mechanism of its action. Thus, it is suitable for any type of vascular headache, which is the case of the patient. However, it is not the first option when planning treatment since this medication is generally used only when severe symptoms cannot be mitigated by other prescriptions (Ngo & Tadi, 2021). Moreover, it has more side effects than any other options and is recommended only for patients with constant headaches or frequent attacks (Ngo & Tadi, 2021). From this perspective, the role of ergotamine is to deal with the symptoms, which cannot be addressed by other medications, and S.D. should be aware that it does not correspond to her needs yet.

Contraindications to the Use of Ergotamine-Containing Products

The use of ergotamine-containing products is accompanied by particular contradictions, which should be taken into account when planning care. It is not recommended to people with “peripheral vascular disorders, coronary artery disease, stroke, uncontrolled hypertension, impaired renal or hepatic function, sepsis, and pregnancy” (Ngo & Tadi, 2021). Moreover, it conflicts with CYP 3A4 inhibitors, and their combined use might be lethal for patients (Ngo & Tadi, 2021). Hence, the above conditions should be viewed as the signs of the unsuitability of ergotamine and other medications, which contain it, for treating migraines. In the case of S.D., there are no other health issues reported, which means that the prescription of this type of treatment can be possible in the future.

The Possibility of Prophylactic Therapy and Other Alternatives

Prophylactic therapy for S.D. is another type of treatment, which should be considered when specific conditions are met. The headaches should occur at least eight times a month, and other prescribed medications should be reported to be ineffective (Schwedt & Garza, 2021). The difficulty tolerating acute therapy or the presence of other conditions, which exclude the possibility of using specific methods, are also included in the list (Schwedt & Garza, 2021). In turn, the medication-overuse headache should also serve as a sufficient basis for making the proposed change (Schwedt & Garza, 2021). It means that the existence of any of the above obstacles in the patient should be viewed as a clear sign of the need to introduce prophylactic therapy as the primary preventive measure. In addition, other alternative options can be considered for pain relief and the overall improvement of S.D.’s health status. They include antiemetics, such as “intravenous (IV) metoclopramide and IV or intramuscular (IM) prochlorperazine” as well as ” haloperidol, chlorpromazine, droperidol, and ondansetron” (Schwedt & Garza, 2021). Thus, the treatment will be efficient if the prescriptions are regularly readjusted following the patient’s reaction.

Conclusion

In conclusion, planning care for S.D. should be performed with regard to the essential circumstances of the matter. First, proper testing is required to obtain a clear picture of her condition. Second, the definition of the type of headache and recommendations of OTC medications should follow its results. Third, the patient should be provided with sufficient information regarding the feasibility of measures, her concerns, and alternatives. Finally, the increased frequency of migraines should be taken into account, and the plan should be readjusted accordingly.

References

Bhargava, H. D. (2020). Migraine and headache diagnosis: Tests and exams used. WebMD. Web.

Ha, H., & Gonzalez, A. (2019). Migraine headache prophylaxis.American Family Physician, 99(1), 17-24. Web.

Ngo, M., & Tadi, P. (2021). Ergotamine/caffeine.StatPearls. Web.

Schwedt, T. J., & Garza, I. (2021). Acute treatment of migraine in adults.UpToDate. Web.

Seladi-Schulman, J. (2021). Over-the-counter migraine medications: Types and usage. Healthline. Web.

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