Wk8 6501 Concepts of Neurological and Musculoskeletal Disorders – Part 2 The patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache.
Concepts of Neurological and Musculoskeletal Disorders
Concepts of Neurological and Musculoskeletal Disorders
The patient presents with severe right-sided headaches that persist for two to three days, nausea and vomiting, and photophobia. These are typical signs and symptoms of migraine. Migraine is a complex neurological disorder that presents with periodic episodes of unilateral headache and sensory manifestations (Peters, 2018). In addition, the pain lasts for about four to 72 hours (Peters, 2018). Nausea occurs in about 80 percent of the cases, whereas vomiting has been reported in 50 percent of the cases (Peters, 2018). Photophobia and phonophobia are the other classical manifestations of migraine (Peters, 2018).
Neurological and Musculoskeletal Pathophysiologic Processes
According to Peters (2018), the pathophysiology of migraine is not well understood. Nonetheless, technological advances have enabled the formulation of theories and concepts to explain its occurrence. According to the vascular theory, intracranial vasoconstriction and the resultant ischemia are responsible for the aura observed in migraine (Peters, 2018). Intracranial vasodilation and the stimulation of perivascular nociceptive nerves accounts are the causal factors of the headache (the pain) (Peters, 2018). According to neurovascular theory, neurogenic factors and variations in cerebral perfusion are the causal agents for migraine (Peters, 2018). The neurogenic factors reported in this theory are the hyperexcitability of neurons in the occipital cortex (Peters, 2018).
According to Ong and De Felice (2018), the cortical spreading depression theory postulates that migraine aura is caused by the excitation of neurons in the cortex of the gray matter. Additionally, the activation of trigeminal fibers is responsible for headaches (Ong & De Felice, 2018). The release of glutamate and potassium facilitates depolarization and the propagation of the cortical spreading depression (Peters, 2018). This theory has also identified other neurotransmitters and substances that increase the likelihood of migraine. They include substance P, nitric oxide, adenosine, serotonin, and metalloproteinases (Ong & De Felice, 2018). They stimulate the perivascular trigeminal nerves and cause headaches. The other risk factors for migraine include hormonal changes during menstruation or pregnancy, diets such as red wine, aged cheese, and head trauma (Peters, 2018).
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Racial and Ethnic Variables that Impact Physiological Functioning
The prevalence of migraine varies based on race. Findings indicate that the incidence of migraine is lower in African-Americans and Asian-Americans (Burch et al., 2021). Findings from a study involving women revealed that the prevalence of migraine is highest among Caucasians (about 20 percent); about 16 percent of the cases were reported in African Americans, whereas about nine percent of the cases were reported in Asian Americans (Burch et al., 2021). Similar findings were reported in a study involving men. Approximately 8.6 percent of the cases were reported in Caucasians, 7.2 percent in African Americans, and about 4.9 percent of the cases were reported in Asian Americans (Burch et al., 2021). The prevalence of migraine in women is about 18 percent, whereas that in men is about six percent (Burch et al., 2021).
According to Burch et al. (2021), findings demonstrate that the incidence of migraine-related nausea and vomiting was lower in African Americans. However, they reported episodes of severe headaches (Burch et al., 2021). Additionally, African Americans are less likely to be disabled by migraine than Caucasians (Burch et al., 2021). Global incidences reveal that the highest incidences of migraine are reported in North America, South America, and Central America. Europe, Asia, and Africa reported the lowest cases, respectively (Ong & De Felice, 2018).
How These Processes Interact to Affect the Patient
Neurological and musculoskeletal pathophysiologic processes such as intracranial vasoconstriction, vasodilation, stimulation of perivascular nociceptive nerves, and the excitation of neurons in the cortex of the gray matter are responsible for migraine (Ong & De Felice, 2018; Peters, 2018). Migraine has a genetic predisposition and is most likely to occur in females (Burch et al., 2021). In addition, it has a racial predisposition and is likely to affect Caucasians compared to African Americans and Asian Americans (Burch et al., 2021).
References
Burch, R., Rizzoli, P., & Loder, E.