Chronic Migraines: A Case Study

Ari Riecke-GonzalesCommunity Health Major

What are chronic migraines?

• A very painful reoccurring unilateral headache.• Often causes a throbbing pain on one side of the head, nausea, vomiting, light sensitivity, and vision impairments.Chronic: persistent, lasting

A New Disability

• According to WHO, migraine is the 20th leading cause of YLDs, accounting for 1.4% of total global YLDs.

• Migraine burden is higher in women• Migraine affects about 11% of the adult

population in Western countries• Prevalence is highest between the ages of 25-

55

What is a case study?

• An in-depth investigation of a single individual

The Case Study: Susie

• 20 years old, no family history, sophomore at WOU• Experiences fatigue, nausea, blindness, pounding

pain in her head, irritability

Susie’s Treatment• Given Esgic– Side effects: extreme fatigue, possible addiction

• How does Susie cope?

The Biopsychosocial Model of DiseaseThe Biopsychosocial Model is a way of understanding how suffering, disease,and illness are affected by multiple levels of organization, from the societal to themolecular. At the practical level, it is a way of understanding the patient’s subjectiveexperience as an essential contributor to accurate diagnosis, health outcomes,and humane care.

Annals of Family Medicine, WWW.ANNFAMED.ORG, Vol.2, No. 6, Dec. 2004

Biological

• 20 year old female• Drug: Esgic (addictive)• No family history of migraine• History of addiction (dad’s side of the family)• Fatigue, nausea, blindness, pounding pain in

her head, irritable• Deals with an eating disorder

Psychological

• Type A personality• “It’s my fault”• Possible depression and/or anxiety• “I don’t think anyone else deals with migraines like mine”• Stress• Worry wart• “I have to be skinny”

Social• Susie gets support from her Mom• Susie does not get support from her Dad• Her sister has trouble understanding• She does not like her main physician from home• Susie chooses not to tell her peers• She does not get along with her boss

Environmental• Healthcare through WOU• Healthcare through Dad’s work• Bad health insurance• Susie attends Western Oregon University• Susie drives a vehicle for work• Susie lives with 5 other people she finds irritating• Susie moved to Oregon (her migraine physician isstill at home

Receives support from her MomDoes not get support from her DadHer sister has trouble understandingShe does not like her main Physician at homeShe chooses not to tell her peersShe does not like her boss

Biopsychosocial Model of Disease

Biology

•20 year old female•Drug: Esgic (addictive)•No family history of migraine•History of addiction (dad’s side of the family)•Fatigue, nausea, blindness, pounding pain in her head, irritable•Deals with an eating disorder

Psychology

Environment

Social

Type A personality“It’s my fault”Possible depression and/or anxiety“I don’t think anyone else deals with migraines like mine”StressWorry wart“I have to be skinny”

Healthcare through WOUHealthcare through Dad’s work (HMSA)Bad health insurance (refuse to cover things)She attends Western Oregon UniversityShe works for public safety (constantly drives a vehicle)She lives with 5 other people she finds irritatingShe moved from home to Oregon (her migraine physician is at home)

The Research

Most people say stress is their #1 trigger for a migraine attack• There is a positive correlation between migraine frequency and frequency of a

stressful event• A migraine ITSELF can be a stressor

Stress can…• Act as a trigger for a migraine attack• Amplify the duration and intensity

• A study showed people with migraines have more stressful events in the year prior to headache onset.

• Individuals with migraine may differ in their manner of coping from healthy adults and they tend to use more internalized styles of coping with stress verses seeking social support.– People with migraines perceive stressors as m ore threatening

• One study found 50.6% of migraine patients examined were depressed and/or anxious.

The Research

• What causes Migraine Chronification?– Risk Factors include (but are not limited to):• Relatively high current headache frequency• Medication overuse• Obesity• Caffeine consumption• Stressful life events• Depression

• Does this relate to Susie?

The research and Susie

• Stressful Events• Her lifestyle• Her personality (coping mechanisms)

Questions?