Shawn Billings, a 28 year-old African American patient

• Discussion 2_Resonse 1

  Great post, Kasondra. Pain is subjective, and it is what the patient says it. Chronic migraine is debilitating; it affects the person’s ability to function normally in the community (Dahlhamer et al., 2018). The patient’s physical and psychological conditions must be considered, in addition to the impact of chronic pain on the patient’s quality of life(Dahlhamer et al., 2018). Indeed, there is a need to do a comprehensive health history and physical assessment so that the nature of pain can be determined and treated accordingly. Sometimes, like today, I had migraines. In general, it affects me when I do not sleep enough. Migraines are excruciating.

  Moreover, a migraine that evolves into chronic migraine is intolerable. The pathophysiology of migraine involves the peripheral and central parts of the trigeminal system as well as several subcortical and cortical of the brain structure (Coppola et al., 2020). Mungoven et al. (2022), using a functional magnetic resonance in their research, found that the variation of brainstem pain modulatory regions by higher cortical zones may be abnormal when pain occurs, and these changes in this descending modulatory route display only before the development of a migraine attack. From their data, the authors derived that understanding the functional changes of the descending pain modulation may lead to the development of treatment methods that will contribute to reducing pain before a migraine attack.

  References

  Coppola, G., Parisi, V., Di Renzo, A., & Pierelli, F. (2020). Cortical pain processing in migraine. Journal of Neural Transmission (Vienna, Austria: 1996), 127(4), 551–566. https://doi.org/10.1007/s00702-019-02089-7Links to an external site.

  Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults – United States, 2016. MMWR. Morbidity and mortality weekly report, 67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

  Mungoven, T. J., Marciszewski, K. K., Macefield, V. G., Macey, P. M., Henderson, L. A., & Meylakh, N. (2022). Alterations in pain processing circuitries in episodic migraine. The Journal of Headache and Pain, 23(1), 9. https://doi.org/10.1186/s10194-021-01381-w

   

response 2

Your post was informative and highlighted some stressors contributing to this patient’s migraines. A lack of the basic necessities for living, such as clean water, healthy food, financial security, housing, education, and access to quality healthcare creates health disparities that can severely influence a patient’s health outcomes. African Americans face health disparities due to poverty, racism, low education level, a lack of medical insurance, and mistrust of healthcare providers (Nair & Adetayo, 2019). Mistrust with healthcare providers results in avoidance to seek out primary care services and contributes to more emergency room visits by African American patients (Alsan et al., 2019). In the US, migraine headaches affect approximately 1 million African American men and can be severely disabling (Charleston et al., 2020). Taking the time to properly address this patient’s concerns, while also being sensitive to his cultural and social differences can help build more trust and fewer feelings of judgment (Andermann, 2016). Getting an official diagnosis of “migraines” for this patient can put him on the path to receiving appropriate evidence-based treatment and neurological care for this condition to prevent or reduce these episodes (Eigenbrodt et al., 2021).

I thought your questions were probative and will be helpful in gathering information for your health assessment. As healthcare providers, I feel we sometimes can become so busy that we rush through things and do not take the time to explain that our questions are not meant to offend or be judgmental but to help find solutions and provide the best care for our patients. So, I love that you included taking the time to explain the importance of your questions so as not to further aggravate the patient. Having the patient’s father present during the assessment (as long as there is patient consent) can help provide information about family history that the patient may not know. Great post! I really enjoyed your perspective on this case scenario.

References

Alsan, M., Garrick, O., & Graziani, G. (2019). Does diversity matter for health? Experimental evidence from Oakland. American Economic Review, 109(12), 4071–4111. https://doi.org/10.1257/aer.20181446Links to an external site.

Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal, 188(17-18), E474–E483. https://doi.org/10.1503/cmaj.160177Links to an external site.

Charleston, L., Spears, R. C., & Flippen, C. (2020). Equity of African American men in headache in the United States: A perspective from African American headache medicine specialists (part 1). Headache: The Journal of Head and Face Pain, 60(10), 2473–2485. https://doi.org/10.1111/head.14004Links to an external site.

Eigenbrodt, A. K., Ashina, H., Khan, S., Diener, H.-C., Mitsikostas, D. D., Sinclair, A. J., Pozo-Rosich, P., Martelletti, P., Ducros, A., Lantéri-Minet, M., Braschinsky, M., del Rio, M., Daniel, O., Özge, A., Mammadbayli, A., Arons, M., Skorobogatykh, K., Romanenko, V., Terwindt, G. M.,…Ashina, M. (2021). Diagnosis and management of migraine in ten steps. Nature Reviews Neurology, 17(8), 501–514. https://doi.org/10.1038/s41582-021-00509-5Links to an external site.

Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery – Global Open, 7(5), e2219. https://doi.org/10.1097/gox.0000000000002219Links to an external site.