Managing the Patient with Migraine: Detailed list of learning objectives:


When evaluating a patient with headaches, the learner will:
• differentiate migraine from other primary and secondary headaches
• evaluate the significance of external factors when told about lifestyle issues, relationship to menstrual cycle and triggers
• inquire about migraine frequency, severity, duration, patterns of onset and uncommon migraine events.
• recognize who is at risk to get chronic daily headaches
• inquire about quality of life issues including suffering, migraine disability, impact on job and family life
• inquire about comorbid states such as personal stressors, depression, anxiety insomnia, etc.
• employ specific medication overuse questions when the patient is describing frequent medication use for headaches.
 
  When presented with a patient with daily headaches, learner will:
• demonstrate improved sensitivity to a possible missed migraine diagnosis and medication overuse,
• differentiate migraine from medical symptoms and medication side effects.
• differentiate chronic daily headaches from tension type headaches and medication overuse headaches
• recognize chronic daily headache
• recognize trends toward daily headache
 
  When presented with a patient not responding well to headache therapy, learner will:
• Inquire about specific symptoms of anxiety, depression, sleep disturbances, marital problems, employment stressors and fear of medications...
• determine the cause of escalating headaches when presented with daily or frequent patterns
 
  When managing a patient with daily or recurrent headaches, learner will:
• demonstrate increased sensitivity to external factors which exacerbate migraine and complicate its treatment.
• identify patients who are good candidates for preventative
• inquire about the cost burden of therapy, difficulties with their insurer and discuss options which are better suited to the patient’s level of coverage.
• demonstrate increased sensitivity to the patient’s quality of life issues including suffering and migraine disability.
• Discuss appropriate expectations
• educate the headache patient and monitor more frequently in the office.
• appraise the patient's degree of compliance with medication, including insurance issues and fears about medication effects
• evaluate the specific headache abortive needs of the patient when they describe headache onset, duration, severity, presence of nausea and neurological deficits
• Demonstrate understanding of preventative treatment strategies, including preventive pharmacology, behavioral/lifestyle techniques
• identify patients who are good candidates for preventative therapy
• practice good communication about outcome expectation when talking with the patient following the development of the preventative treatment strategy.
• monitor the migraine patient, including increased use of headache diaries, documented comments on effectiveness of treatment plan, effectiveness, tolerability, compliance, adjustments of plan, outcomes.
• employ patient education materials.
• employ regular specific migraine follow-up visits.
• inquire about the cost burden of therapy, difficulties with their insurer and discuss options which are better suited to the patient’s level of coverage.
• monitor the patient's understanding of their condition and medications when assessing their understanding of their condition...