Diagnostic Approach for Migraine Headache, With a Comparison of Subcutaneous and Intranasal Treatment Options

Thesis (M.Nurs.), College of Nursing, Washington State UniversityHeadache is the second most common health complaint in the United States today (Barrett, 1996). Migraine headaches ('migraine' or 'migraines') cause a great deal of pain and suffering for an estimated 23 million people in the United States, with the majority of sufferers being women (Lipton, Stewart, & von KortI, 1997). Costs for treatment of patients who suffer from migraine headaches ('migraineurs') can be significant, as can the costs associated with their lost work time (Starr, 1998; Osterhaus, Gutterman, & Plachetka, 1992; Litaker, Solomon, & Genzen, 1997). The diagnosis of migraine is dependant on signs and symptoms, a complete history and physical examination, the ruling-out ofdifferential diagnoses, and supportive laboratory tests. Migraines can be associated with 'triggering' events or situations ('triggers') which appear to affect a 'migraine generator' that is believed to be located in the brain stem, possibly in the dorsal raphe nuclei, the locus cerolus, and/or the periaqueductal gray region (Smith, 1998). The 'aura' of migraine appears to result from changes in cortical activation and to correlate with a spreading depression (Peroutka, 1990). Local cranial vasodilation, or the release of sensory neuropeptides through nerve endings in the trigeminal system may also cause migraines. The neurotransmitter, serotonin, has recently been shown to play a role in migraines (Nagelhout, & Beauchamp, 1997). A review of literature documenting studies of subcutaneous treatments with sumatriptan and dihydroergotamine revealed that, while subcutaneous injections of either medication can be effective in the treatment of migraines, the treatments were not always successful with a single dose, especially with sumatriptan. Additionally, self-injection was difficult for many patients to perform. A review of literature documenting studies of intranasal treatments with sumatriptan and dihydroergotamine revealed that this route of administration is often easier for patients to petform, is well-tolerated by patients, and represents an important treatment option for migraine sufferers