Migraine Management Plan

The first step in Susan’s plan should focus on improving her abortive therapy and assessing any probable triggers for her constant migraine attacks. Considering she takes sumatriptan more commonly than the recommended two to three times per month, she may develop medication-overuse headaches. A detailed assessment is necessary, paying attention to the patient’s caffeine use and intake of over-the-counter analgesics such as Excedrin Migraine, which has caffeine and might increase her headaches (Zduńska et al., 2023): Migraine Management Plan.

It is vital to educate her that reducing caffeine intake and avoiding other analgesics without a prescription is necessary. The plan should also include starting a headache diary and scheduling a second visit to check her headache patterns and treatment results.

When she comes back with her complete diary, the focus will be to assess the frequency, severity, duration, and potential triggers of her migraines. It is essential to record the medicines taken, their effectiveness, changes in the menstrual cycle, sleep patterns, stress levels, and dietary habits. If she continues to experience migraines more than four times each month or if they negatively impact her quality of life, starting prophylactic therapy might be necessary.

Emphasizing non-pharmacological approaches such as cognitive-behavioral therapy, good sleep habits, and lifestyle changes is also essential (Haghdoost & Togha, 2022). Changes to the follow-up plan would be made after evaluating both the diary and the patient’s responses to therapy.

Several medications are available for migraine prophylaxis and should be considered for patients with frequent or debilitating attacks. Beta-blockers like propranolol, anticonvulsants such as topiramate or valproate, and tricyclic antidepressants such as amitriptyline are often used as first-line treatment for migraines, depending on other comorbidities and how the patient tolerates them (Kumar & Kadian, 2023). Other options include calcitonin-gene-related peptide monoclonal antibodies such as erenumab and galcanezumab, which help decrease migraine frequency with few side effects.

Preventive therapy aims to lower the frequency and intensity of headaches and improve one’s ability to function. A personalized approach is key to successful management and helps avoid rebound headaches.

References

Haghdoost, F., & Togha, M. (2022). Migraine management: Non-pharmacological points for patients and health care professionals. Open Medicine, 17(1), 1869–1882. https://doi.org/10.1515/med-2022-0598

Kumar, A., & Kadian, R. (2023, August 28). Migraine prophylaxis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507873/

Zduńska, A., Cegielska, J., Zduński, S., & Domitrz, I. (2023). Caffeine for headaches: Helpful or harmful? A brief review of the literature. Nutrients, 15(14), 3170. https://doi.org/10.3390/nu15143170

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Week 3 Discussion: Case Study # 1
Please read the following Case Study and answer the questions posed.

Complaint
“My migraine headaches will not go away.”

History
A 32-year-old female presents to the clinic with recurrent migraine. She reports that she has a moderate to severe migraine once a week, on average. She uses SC Imitrex (sumatriptan), and most of the time the headache resolves with one dose. She was told to return for a checkup if she had to use the Imitrex more than two or three times a month.

Susan is married and has four children. She experienced her first migraine at age 18 and has no other health problems. She was started on Imitrex and has had good results. She is otherwise healthy.

She reports a two to four cup a day intake of coffee; usually, one of those “cups” is a double latte. She occasionally uses Excedrin Migraine for relief of mild headache— she thinks only once or twice a week. She has never been hospitalized overnight for her migraines but has gone to the emergency room for “pain medicine” before she was started on Imitrex.

Migraine Management Plan

Assessment
Susan is afebrile, vital signs are all within normal limits (WNL), and her weight is 135 pounds (body mass index [BMI] is 24), which is stable.