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