1. Chronic Migraines: A Case Study Ari Riecke-Gonzales Community Health Major

2. 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

3. A New Disability According to WHO, migraine is the 20 th 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

4. What is a case study? An in-depth investigation of a single individual

5. The Case Study: Susie 20 years old, no family history, sophomore at WOU Experiences fatigue, nausea, blindness, pounding pain in her head, irritability

6. Susie’s Treatment Given Esgic – Side effects: extreme fatigue, possible addiction How does Susie cope?

7. The Biopsychosocial Model of Disease The Biopsychosocial Model is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjective experience 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

8. 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

9. 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”

10. 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

11. 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 is still at home

12. Receives support from her Mom Does not get support from her Dad Her sister has trouble understanding She does not like her main Physician at home She chooses not to tell her peers She 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” Stress Worry wart “I have to be skinny” Healthcare through WOU Healthcare through Dad’s work (HMSA) Bad health insurance (refuse to cover things) She attends Western Oregon University She works for public safety (constantly drives a vehicle) She lives with 5 other people she finds irritating She moved from home to Oregon (her migraine physician is at home)

13. 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.

14. 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?

15. The research and Susie Stressful Events Her lifestyle Her personality (coping mechanisms)

16. Questions?