Migraine: management aetiology and diagnosis

Migraine is an episodic condition that significantly affects the quality of life of those who experience it. The headache may manifest with or without sensory or visual aura. This article explains what migraine is, why it differs from other headaches and what drug therapies are available to treat it. It also includes health promotion advice on the best ways to prevent attacks. The author stresses that the impact of migraine on quality of life should not be underestimated. It is vital to give control back to sufferers rather than let migraine control them.     

Cluster headache: aetiology, diagnosis and management.

Drugs . 2002;62(1):61-69
Cluster headache is characterised by repeated attacks of strictly unilateral pain in the orbital region associated with local autonomic symptoms or signs. The attacks are brief but of a very severe, almost excruciating intensity. For unknown reasons males are affected more often than females. Recent studies suggest that an autosomal dominant gene has a role in some families with cluster headache. Hormonal studies indicate a dysfunction in the central nervous system. Neuroimaging has revealed primary defects in the hypothalamic grey matter. Local homolateral dilatation in the intracranial segment of the internal carotid and ophthalmic arteries during attacks is the result of a generic neurovascular activation, probably mediated by trigeminal parasympathetic reflexes. Sumatriptan 6mg subcutaneously is the drug of choice in the treatment of acute attacks. Inhalation of 100% oxygen can also be recommended. In the prophylactic treatment, verapamil is the first option. Other drugs that can be considered are corticosteroids, which may induce a remission of frequent, severe attacks, and lithium. Oral ergotamine tartrate may be sufficient for patients with night attacks and/or short, rather mild to moderately severe cluster headache periods. Third line drugs are serotonin inhibitors (methysergide and pizotifen) and valproic acid. Patients should be encouraged to keep headache diaries and be carefully instructed about the nature and treatment of the headaches. Alcohol can bring on extra attacks and should not be consumed during active periods of cluster headache.
Comment: A useful review of clinical options. Given the effectiveness of injectable sumatriptan and the prophylactic use of ergotamine mentioned, one might speculate that the new intranasal formulations of triptans (eg, zolmitriptan) and triptans with a longer half-life (eg, frovatriptan) may prove to be effective in the treatment of cluster headache. DSM     

Fibromyalgia: patient perspectives on symptoms, symptom management, and provider utilization

Two surveys of individuals with fibromyalgia were conducted to assess the frequency and prevalence of symptoms (N = 99) as well as healthcare providers, medications, and self-care activities used to manage one's fibromyalgia (N = 54). The pervasiveness of symptoms was striking, with 24 various symptoms ranging from cognitive to intestinal problems occurring in at least 75% of the respondents. Significant correlations were present between health status and both physical (P = .002) and psychological (P =.008) symptoms. There was also a significant correlation between the total number of symptoms and the degree of life disruption attributed to fibromyalgia (P =.015). A variety of healthcare professionals were seen, with internists, family physicians, and rheumatologist most frequently used. Although at least 80% of the respondents reported difficulty with anxiety, confusion, irritability, depression, and cognitive difficulties, less than 10% of the respondents reported seeing a psychiatrist. Most frequently used medications were: amitriptyline, (fluoxetine HCl) Prozac, ibuprofen (Motrin), sertraline HCI (Zoloft), and zolpidem (Ambein). Self-care activities used with the most success were walking, stretching, and exercising. These studies indicate the need for more research and support for healthcare providers as well as patients with fibromyalgia.     

Delirium in the terminally-ill cancer patient: aetiology,symptoms and management

Delirium is a frequent and serious clinical problem in the terminally ill cancer patient. Multiple dimensions of delirium make definition, measurement, and assessment of it challenging in clinical nursing practice. Assessment and management of delirium requires knowledge of the diagnostic criteria for it, aetiology, signs and symptoms, and nursing interventions. Four delirium assessment scales determined to be useful in assessing patients with terminal illness are reviewed. The use of a delirium assessment instrument in routine nursing assessments would be important for the nurse's early detection of delirium so that interventions to reverse the causes of delirium could immediately be implemented.     

Paediatric atopic dermatitis: parameters of aetiology, diagnosis and management

Atopic dermatitis is not merely a skin condition. It can have a profound physical and psychological effect on the child and his/her family. This article discusses aetiology of the disease and describes appropriate management strategies.     

Ectopic pregnancy: symptoms, diagnosis and management

Ectopic pregnancy is the third biggest killer of pregnant women in the UK. Misdiagnosis and delay in treatment remain common problems, which feature in the Department of Health's last two confidential inquiries into maternal death. This article outlines the symptoms and management of ectopic pregnancy as well as high-lighting its psychological and physical effects.     

Acute pancreatitis: symptoms, diagnosis and management

Pancreatitis is a relatively common condition that affects approximately one per cent of the population. Although the majority of attacks are mild, it is fatal in one in four people who develop it in a severe form. Clinical manifestations are so varied that the condition should be considered in the differential diagnosis of all upper abdominal pain until serum amylase concentrations become normal. Specific treatment is unavailable, therefore therapy is supportive, including the management of complications if and when they develop.     

Rheumatoid arthritis: symptoms, diagnosis, and management

Rheumatoid arthritis is the most common inflammatory joint disease and a major cause of disability, morbidity, and mortality. It occurs worldwide, affecting approximately one per cent of adults. Inflammation of the synovial membrane surrounding a joint leads to swollen, tender, and stiff joints. This may be accompanied by fatigue, weight loss, anxiety, and depression. Nursing management goals should include the relief of symptoms, preservation of joint function, prevention of joint damage and deformity, maintenance of an acceptable lifestyle, and patient education. To achieve these aims the nurse should play a pivotal role within the multidisciplinary team, ensuring the highest quality of care.     

Fibromyalgia: The diagnosis and pharmacologic treatment

Fibromyalgia (FM) is a chronic condition characterized by widespread pain and diffuse tenderness along with a constellation of ancillary symptoms. The 1990 ACR criteria for classification of FM are important in enhancing much the research of FM. FM is part of a spectrum of functional somatic syndromes. FM is not a homogenous condition and several subtypes of FM had been determined. The best strategy for management of FM is to use a multidisciplinary approach to treatment using both pharmacological and non-pharmacological interventions.Tramadol, tricyclic drugs, mixed reuptake inhibitors and anticonvulsants show efficacy in this condition. Recently, three drugs: pregabalin, duloxetine and milnacipran have been approved by the FDA for treatment of FM.     

Fibromyalgia: Progress in diagnosis and treatment

Fibromyalgia is a frequent cause of chronic widespread pain and affects up to 5% of the general population. Diagnosis and treatment have been especially challenging due to limited knowledge of etiology and poor response to conventional treatment of pain. Appreciation for the interactions of neurobiologic, psychologic, and behavioral factors in the disease pathogenesis has led to improved treatment options that can be effective in individual patients. Current evidence advocates a multifaceted program emphasizing patient education, medications for improving symptoms, and aggressive use of exercise and cognitive-behavioral approaches to retain or restore function.     

Classification, aetiology and nursing management of lymphoedema

Lymphoedema is a common problem affecting at least 100,000 people in the United Kingdom. There is a lack of knowledge among healthcare professionals regarding lymphoedema and this has led to the condition often not being recognized early enough or being adequately managed. Lymphoedema is an incurable condition which will progress if it is not appropriately treated. Physical problems associated with lymphoedema may include pain, discomfort, heaviness of the limb and distortion in limb shape and size leading to reduced mobility and function. This has implications for lymphoedema patients who may experience a significant reduction in their quality of life because of this condition. Treatment, if commenced early, is straightforward and patients can be taught to carry out an effective programme of daily self-care. If, on the other hand, the lymphoedema is not recognized early or not properly treated, it can develop into a serious and highly debilitating condition.     

Colorectal cancer. Part 1: Epidemiology, aetiology, screening and diagnosis

Colorectal cancer causes significant mortality and morbidity in industrialised countries. Screening populations at an average risk of developing colorectal cancer by faecal occult blood testing can significantly reduce mortality. Nurses have a crucial role to play in educating the public about the warning signs of colorectal cancer and promoting uptake of screening.     

Assessment,diagnosis and management of lower urinary tract symptoms in men

Lower urinary tract symptoms are very common and the approach to assessment and management has changed dramatically over the past few years. Previously referred to as prostatism, benign prostatic hyperplasia and bladder outflow obstruction, it is now recognised that in most men symptoms are due to a combination of benign prostatic enlargement and age-related bladder dysfunction. Most men require only simple tests for a diagnosis, with the more complex investigations reserved for when the diagnosis is not clear. Symptom bothersomeness and effect on quality of life are the critical factors when deciding how to treat a man. A cascade of treatments exists, including conservative management, medical therapy and surgery. A man moves up the cascade when the present management strategy fails to control symptoms. Traditional surgical techniques such as transurethral resection of the prostate are still appropriate for some men, although with improved medical treatments available the number of men undergoing surgery is declining.     

Wegener's granulomatosis: symptoms, diagnosis, and treatment

PURPOSE: To provide nurse practitioners with a basic understanding of the clinical presentation, diagnosis, diagnostic testing, pharmacological treatment, and prevalence of Wegener's granulomatosis (WG). DATA SOURCES: Published research and clinical articles, and a case report. CONCLUSIONS: WG is a systemic disease characterized by vasculitis, necrosis, and granulomas. The diagnosis of WG is difficult, particularly early in the disease process. In order to confirm the diagnosis, the patient should undergo specific tests such as antineutrophil cytoplasm antibodies, erythrocyte sedimentation rate, C-reactive protein, and biopsy of the tissue involved. IMPLICATIONS FOR PRACTICE: The diagnosis of WG is often delayed because of the vague symptoms on presentation. Initial symptoms, such as chronic fatigue, upper respiratory infection, sinusitis, and otitis media are common and may not be alarming. Recognizing symptoms, ordering diagnostic tests, and providing appropriate pharmacological therapy is key to diagnosing and treating WG.