Migraine is a disorder of the brain that affects both men and women. According to (Lambru, Andreou, Guglielmetti & Martelletti, 2018) the disorder has a prevalence of about 33% among women and 12% among men. The disorder is associated with detrimental impact on the quality of life and the impact on the socio-economic wellbeing of the individuals affected. The disease is characterized by neurological and psychological symptoms, with common being fatigue, nausea, irritability, and impaired concentration. According to the authors, the symptoms can last even up to 60 minutes after which the patient begins to have headache that can last up to 72 hours. Migraine can be chronic or acute, where patients with chronic migraine experiencing at least 15 headache days in a month.
The case of Isabel, the 26-year old female graduate, represents an acute form of migraine. According to (Becker, 2015) the treatment of migraine has a long history as the patient and the physician try to relief pain associated with the disorder. The author points that caffeine has been a traditional way of relieving pain that is associated with migraine. However, recent evidence has shown that the response to medications among individual patients with migraine is idiosyncratic and must be tailored to suit individual patients. In the case of Isabel, the use of naproxen (Aleve) in the treatment of the acute migraine has led to recurrence of headaches despite the fact that the medication is appropriate form of treatment. In addition, there is need to understand other factors as potential forms of treatment other than prescription of medication. Therefore, the treatment of the effective treatment of the case must involve both medications and consideration of other modalities such as lifestyle modification and management of other triggers such as work pressure.
Drug Treatment
Based on the case that the use of naproxen (Aleve) has not been successful in treatment of the migraine, the recommended treatment will be a combination of triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) medications. It is recommended that the patient takes a combination of sumatriptan and naproxen.
Oral Sumatriptan
It is recommended that the patient takes daily dosage of 50 mg of sumatriptan taken at an interval of 2 hours, with a maximum daily dose of 200 mg. The triptan should be taken for a period not exceeding 10 days in a month to avoid risk of exacerbating the headaches.
Oral Naproxen
It is recommended that the patient takes naproxen (sodium) with a daily dosage of 500-550 (and not exceeding 825) mg taken 2 times a day up to a maximum of 1375 mg for a period of not more than 15 days to avoid risks of medication overuse headaches. The NSAIDS should be taken in combination with the oral sumatriptan for better headache relieve.
The clinical trials that have been undertaken have shown that a combination of triptans and NSAIDS provides a better management of headaches among patients having migraines. According to (Pardutz & Schoenen, 2010) clinical trials have shown that a combination of sumatriptan and naproxen have superior outcomes compared to single compounds. Moreover, sumatriptan was found not to be superior alone naproxen in pain relief within 2 hours, but showed better pain relief.
It is imperative that the contraindications be discussed with the patient and to determine if the patient has other disorders such as stroke and cardiovascular diseases. The use of sumatriptan can cause adverse effects such as hot sensation and dizziness, which should be discussed with the patient. The drugs are easily available over the counter and are affordable.
Non-Drug Treatment
Isabel is sleep deprived as she combines work and school, creating a lot of pressure. In addition, she has got no healthy relationships and shows inconsistent participation in daily exercises. According to (Becker, 2015) lifestyle factors such stress, lack of enough sleep, and workplace pressure can contribute to intractability in migraine treatment. The patient will be advised to change her lifestyle modalities such as consistent exercises and creating a good balance between work and study. In addition, Isabel will be advised to develop healthy relationship. As a result, the patient will be referred to a qualified nurse psychiatrist for further assessment, diagnosis and treatment of stress and lifestyle modalities that could be linked with increased headaches.
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