25 Apr A 46-year-old white male comes in for evaluation of his migraine headache management

A 46-year-old white male comes in for evaluation of his migraine headache management.  His medical history is inclusive for hypertension and a myocardial infarction at the age of 39. He was diagnosed with migraine headaches three years ago.

 Current medications include Losartan 50 mg a day, verapamil SR 100 mg at bedtime, Carvedilol 25 mg a day, Lipitor 40 mg a day, Topamax 50mg a day

 He has been admitted to the hospital for migraine management 3 times over the last 6 months. Inpatient admissions have ranged anywhere from 3 to 6 days. Management strategies utilized during the hospitalization include IV corticosteroids, IV Dilaudid and IV magnesium sulfate.

 BP 132/84, P 82, R 15  Skin: pink, warm, dry  Neuro: alert and oriented, CNs II – XII intact  Cardio: radial and pedal pulses 2+, heart regular rate and rhythm

without murmur or gallop  Lungs: clear to auscultation  Abdomen: large, non-distended, active bowel sounds all quadrants,

non-tender to palpation

S: a 46-year-old Caucasian man presents with a three year history of migraine headaches for management evaluation. He has additional medical history of hypertension and a myocardial infarction at age 39. His medications include Losartan 50mg daily, Verapamil SR 100mg at night, Carvedilol 25mg daily, Lipitor 40mg daily and Topamax 50mg daily. He has had three half week to week admissions in the past six months for migraines and received IV Dilaudid, corticosteroids and magnesium sulfate as treatment.

O: VS: BP 132/84, P 82, R 15; Skin is warm, dry, pink in color. Neuro, pt is A&O with cranial nerves II-XII intact; Pulses +2, HR regular

A: Migraines

P: Therapeutic: Per Arcangelo et al. (2017), the goal in treating this patient’s migraines is to prevent and relieve his attacks with minimal side effects. In the acute time frame, treatment goals include reducing the migraine severity, amount of migraine days and nausea. In addition to the short term goals, long term goals also include decreasing disability, increasing quality of life, avoiding increases in medication(s), providing education and empowering the patient to manage his migraine disorder. During assessment, a detailed account of the patient’s headaches should be retrieved including what period of the day his migraines usually occur, how long the last, how often they occur, presence of an aura, identified factors that may cause or relieve it, the quality, location and severity of his migraine pain, if he experiences any other