NUR 631 Topic 6 DQ 2

Sample Answer for NUR 631 Topic 6 DQ 2 Included After Question

Use information provided and the “Discussion Forum Sample” to answer the following questions.

Scenario

J.R. presents to her PCP with a chief complaint of “pounding and throbbing” headache, and this is the fourth time this month she has experienced this type of headache. The patient is a 45-year-old Caucasian female who appears slightly overweight. She describes her headache at the right temple and having a pain score of 9/10. She denies any pain in the orbit or cheek. She denies lacrimation and rhinorrhea. She is sensitive to the lights in the clinic which make her feels nauseous and dizzy but has not vomited. She denies sensitivity to sound. Previous similar headaches have lasted about 6 hours, have not been responsive to any type of OTC medication, and do not appear to be associated with menses. In addition, she feels exhausted when the headaches finally subside and often fall into a long, deep sleep afterward. She has no known allergies, does not use alcohol or tobacco products, and denies the use of illegal drugs. She sleeps only about 5 hours every night and has rather poor eating habits. She eats “more chocolate than she should” and drinks three or four caffeinated soft drinks every day.

Blood Chemistry Panel

  • Na+ = 144 meq/L
  • K+ = 3.7 meq/L
  • Ca+2 = 8.5 mg/dL
  • Mg+2 = 0.9 mg/dL
  • PO4-3 = 2.7 mg/dL
  • Cl- = 110 meq/L
  • HCO- = 30meq/L 3

Questions

  1. List four potential precipitating factors or contributing factors for migraines in this patient. Explain your answer.
  2. Identify the single abnormal finding in the blood chemistry panel above and explain its possible association with the patient’s migraine headaches.
  3. Identify five features of the patient’s headache that help exclude cluster headache as a potential diagnosis.

A Sample Answer For the Assignment: NUR 631 Topic 6 DQ 2

Title: NUR 631 Topic 6 DQ 2

The single abnormal finding in the blood chemistry panel is hypomagnesemia, which is a low serum magnesium concentration. Hypomagnesemia can be associated with migraine headaches. Magnesium is involved in numerous physiological processes in the body, including the regulation of blood vessels and neurotransmitters.

In migraine pathophysiology, magnesium plays a role in modulating the excitability of neurons and regulating cerebral blood flow. It is believed that low levels of magnesium can contribute to increased neuronal excitability and vasoconstriction, both of which are implicated in migraine attacks.

Low magnesium levels have been found in some individuals with migraines, and magnesium supplementation has shown promise in the prevention and treatment of migraines. Magnesium supplementation can help restore the balance of magnesium in the body and potentially reduce the frequency and severity of migraine attacks. The patient’s hypomagnesemia may be associated with her migraine headaches, and addressing this abnormal finding through magnesium supplementation could potentially help alleviate her symptoms.

Based on the provided information, the following five features of the patient’s headache help exclude cluster headache as a potential diagnosis:

1. The patient’s headache is not primarily occurring on one side of the head. Cluster headaches typically occur on one side of the head.

2. The nature of the pain is not described as severe, stabbing, and throbbing, which are characteristic features of cluster headaches. Instead, the patient’s headache is described as pulsating and accompanied by nausea, sensitivity to light, and exhaustion, which are more indicative of migraines.

3. The patient’s headache does not occur in clusters of multiple attacks per day with short durations. Instead, the headache persists for 2-3 days at a time, which is not consistent with the episodic pattern seen in cluster headaches.

4. Cluster headaches have extreme pain intensity, often described as one of the most severe types of headaches. However, the patient’s headache is not described as having extreme intensity but rather moderate severity.

5. The absence of sensitivity to light, nausea, dizziness, or feeling exhausted is inconsistent with the symptoms commonly associated with cluster headaches. These symptoms are more commonly observed in migraines.

Considering these five features, it is unlikely that the patient’s headache is indicative of cluster headaches and instead suggests a migraine headache diagnosis. However, it is important for the patient to consult a healthcare professional for an accurate diagnosis and appropriate management.

A Sample Answer 2 For the Assignment: NUR 631 Topic 6 DQ 2

Title: NUR 631 Topic 6 DQ 2

  1. J.R. presents to her primary care provider with a chief complaint of a “pounding and throbbing” headache. This type of headache has precipitated discomfort and creates a 9 out of 10 pain level on the scale. The patient is sensitive to light, feels nauseous, and has complaints of dizziness. The patient is experiencing a migraine according to the symptoms. She does not have any other risk factors as she denies using alcohol and tobacco products, but she does have a poor sleeping schedule as well as questionable eating habits. The other risk factors that may contribute to migraines include drinking “three to four caffeinated soft drinks every day”. According to Pescador and De Jesus, a migraine is a “genetically influenced complex disorder characterized by episodes of moderate-to-severe headache” and may generally be associated with nausea, dizziness, and light sensibility (2023). Migraine headaches can occur from different precipitating factors, four of which include inadequate sleep, poor eating habits, stress, and hormonal changes. The patient may also be experiencing migraine without aura, which is essentially a recurring headache attack of 4 to 72 hours, and is unilateral with pulsations and moderate to severe, it typically follows nausea, light, and sound sensitivity (Pescador & De Jesus, 2023). In 80% of migraines, stress is the most common factor, followed by hormonal changes (65%), skipped meals (57%), and excessive or insufficient sleep (50%), J.R. presents with these factors thus making the migraine headache diagnosis (Pescador & De Jesus, 2023). Overeating chocolate is not proven to lead to chronic migraines or headaches.
  2. The single abnormal laboratory finding in J. R’s case is that the magnesium level is at a critical level of below 1.7 mg/dL. J.R.’s magnesium level is 0.9. The magnesium level and possible association with the patient’s migraine headaches indicate that hypomagnesemia may lead to migraine attacks because of cellular function and energy production in the brain (Domitrz &Cegielska, 2022). The patient’s other labs do not seem to correlate with the migraine attacks that the patient is experiencing. One theory behind hypomagnesemia contributing to migraines is that certain neurotransmitters in the brain require electrolytes such as magnesium and calcium to function appropriately, for example, the N-methyl-D-aspartate (NMDA) receptor. According to Domitrz & Cegielska, proper magnesium and calcium metabolism is required for the functioning of the NMDA receptor as the magnesium ion “blocks the calcium channel in the NMDA receptor” that normally protects the cells against the uncontrolled intake of calcium ions (2023). Essentially, hypomagnesemia can “enhance glutamatergic neurotransmission” and promote excitotoxicity which can ultimately lead to oxidative stress, plus it also reduces the gating of nociceptive sensations in the spine (Domitrz & Cegielska, 2023). 
  3. According to McCance et.al, a cluster headache occurs mostly in men between 20 to 50 years of age and is known as trigeminal autonomic cephalalgia, it is a rare disorder and is associated with stabbing, throbbing headaches (2019). Another type of cluster headache is chronic paroxysmal hemicrania (CPH), which is also a unilateral cluster-type headache that may happen up to 12 times per day and is associated with autonomic features such as teary eyes (lacrimation) and runny nose (rhinorrhea), and may happen daily (McCance et.al, 2023). We can make a differential diagnosis in J.R.’s case as the patient denies both rhinorrhea and lacrimation, plus she denies pain in the orbit or cheek and has only experienced the migraine for the fourth time that month. A cluster type of headache spans several attacks per day and may last for hours up to days, with pain mostly radiating from side to side and following episodes of spontaneous remission (McCance et.al, 2019). Other features that help exclude cluster headaches as potential diagnoses include nausea, photosensitivity, sleeping for a long time following the headaches, denying sensitivity to sound, and only having unilateral throbbing pain. 

References:

Domitrz, I., & Cegielska, J. (2022). Magnesium as an Important Factor in the Pathogenesis and Treatment of Migraine-From Theory to Practice. Nutrients14(5), 1089. https://doi.org/10.3390/nu14051089

McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children (Eighth ed.). Elsevier.

Pescador Ruschel MA, De Jesus O. Migraine Headache. [Updated 2023 Feb 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560787/