Learning Outcomes # 2. Clinical manifestations and neurological symptoms.

Ange M. Pompee-Synsmir, MSN ARNP FNP-BC

Learning Objectives

By the end of the session, participants will:1. Describe clinical manifestations, signs and symptoms of migraine

headaches.2. Develop proficiency and demonstrate a systematic approach in

the evaluation of patients who present with acute migrainous headache.

Participants will receive a self assessment quiz and an evaluation at the end of the lecture; and will receive immediate feedback to clarify any misunderstandings.

Migraine Headaches

Signs and Symptoms of Migraine• Throbbing, pulsating headache• Unilateral and localized pain in the frontotemporal and ocular area.• Nausea and vomiting• Photophobia and PhonophobiaNeurologic symptoms may include:Hemiparesis (this symptom defines hemiplegic migraine)AphasiaVisual Field defects (scotoma, light flashes, visual hallucinations)ConfusionParesthesias or numbness

(http://emedicine.medscape.com/article/1142556-clinical)

Migraine Symptoms and Stages

Migraine Without Aura

Attacks lasting 4-72 hours

At least two of following characteristics: unilateral, pulsating, moderate to severe, aggravated by movement

At least one associated symptom: nausea or vomiting, photophobia and phonophobia.

http://www.achenet.org/resources/types_of_headaches/

Migraine with AuraOne or more transient focal aura symptoms

Gradual development of aura symptom over >4 minutes

Aura symptoms last 4 to 60 minutes

Headache follows or accompanies the aura within 60 minutes

Migraine VariantsHemiplegic (familial)

Basilar

Ophthalmologic

Transient migrainous accompaniments

http://www.achenet.org/resources/types_of_headaches/

Migraine VariantsHemiplegic (familial)

Basilar

Ophthalmologic

Transient migrainous accompaniments

http://www.achenet.org/resources/types_of_headaches/

Migraine headaches cont’d.

Migraines

Migraine Assessment

Goal of Therapy in Treatment of Migraine

The goals of both pharmacologic and nonpharmacological treatment of migraine are:Reduce attack frequency, severity, and disabilityReduce reliance on poorly tolerated, ineffective, or unwanted acute

pharmacotherapies Improve quality of lifeAvoid acute headache medication escalationEducate and enable patients to manage their disease to enhance

personal control of their migraineReduce headache-related distress and psychological symptoms

The End