Primary Diagnosis
Migraine without aura (G43.0)
Migraine is one of the most common and unpleasant neurologic disorders children and adolescents could suffer from (Gelfand, 2013, p. 262). The peculiar feature of this disease is its attacks and the inability to decrease the volume of pain. Still, the level of pain in children and adolescents is lower in comparison to the level of pain experienced by adults. Besides, children and adolescents could suffer from migraine for about an hour or two, and adult migraine could last for four hours (Gelfand, 2013, p. 262). Abdominal migraine, vomiting, and dizziness are the syndromes that cannot be neglected. Still, the periods before and after migraines are usually characterized by a healthy condition with no evident problems. The rationale of such a primary diagnosis for Julia could be the statements she shares with a doctor. For example, she admits that she suffers from a pulsing headache that occurs once or twice per week and can last about one or two days. It is hard for her to watch TV and read books. Besides, she tells about some stomach pain without vomiting. No relief from Ibuprofen and Naprosyn is observed.
Treatment Plan
Diagnostics
Blood tests could be offered to identify if there are some blood vessel problems or other infections that could influence the work of the brain (Sheridan, Meckler, Spiro, Koch, & Hansen, 2013, p.1635).
CT (computerized tomography) includes a number of X-rays with the help of which the image of the brain could be created and analyzed to approve/disprove the diagnosis.
Medication
Rx: Axert, 6.25 mg. Sig.: two times per day, orally. Disp. # 30, Refill 1 (Gelfand, 2013, p. 263).
Rx: Rizatriptan, 10 mg. Sig.: two times per day, orally. Disp. #30, Refill 1 (Gelfand, 2013, p. 263).
Gelfand (2013) investigated the use of two triptans at the same time and proved that it was effective and not harmful for children and adolescents to reduce the level of pain and avoid problems with the stomach.
Conservative Measures
It is suggested for Julia’s family to reduce the cases of psychological disturbances in the child’s life because they are also difficult to treat (Balottin, Poli, Termine, Molteni, & Galli, 2013, p. 120). If Julia finds TV or computer as the possible method to reduce or neglect pain, parents should not prevent these activities because not all medications and therapies could help to prevent migraines. Everything that could be done is to survive this pain and not let it influence other body systems or promote the development of mental problems.
Education
The patient should understand that migraine is not just a headache, it is a kind of pain that cannot be controlled or avoided, and painful attacks could be observed (Raieli et al., 2015, p. 185). Pain may develop and influence the work of other organs. Therefore, it is better to take a rest and choose the activities that Julia finds interesting and appropriate at the moment. Family or other health supporters have to create the conditions to minimize the level of disturbance and provide some relaxation techniques, behavioral strategies, and solutions (Fisher, Law, Palermo, & Eccleston, 2015).
Referrals
In addition to primary care providers, it is offered to consult with a physician and a neurologist (DeVries et al., 2014, p. 130).
Follow-Ups
If migraine does not result in some dangerous for human health conditions, it is possible to visit a doctor in one month in order to check the effectiveness of medications, analyze headaches, and discuss additional therapies with an expert.
References
Balottin, U., Poli, P. F., Termine, C., Molteni, S., & Galli, F. (2013). Psychopathological symptoms in child and adolescent migraine and tension-type headache: A meta-analysis. Cephalalgia, 33(2), 112-122.
DeVries, A., Koch, T., Wall, E., Getchius, T., Chi, W., & Rosenberg, A. (2014). Opioid use among adolescent patient treated for headache. Journal of Adolescent Health, 55(1), 128-133.
Fisher, E., Law, E., Palermo, T.M., & Eccleston, C. (2015). Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents.Cochrane Database Systematic Review. Web.
Gelfand, A. A. (2013). Migraine and childhood periodic syndromes in children and adolescents. Current Opinion in Neurology, 26(3), 262-268.
Raieli, V., Giordano, G., Spitaleri, C., Consolo, F., Buffa, D., Santangelo, G.,… & D’Amelio, M. (2015). Migraine and cranial autonomic symptoms in children and adolescents: A clinical study. Journal of Child Neurology, 30(2), 182-186.
Sheridan, D. C., Meckler, G. D., Spiro, D. M., Koch, T. K., & Hansen, M. L. (2013). Diagnostic testing and treatment of pediatric headache in the emergency department. The Journal of Pediatrics, 163(6), 1634-1637.