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Table 1.

Case Study: Clinical Considerations for a Lifestyle Redesign® Client With Chronic Migraine Headaches

Migraine Risk FactorsClinical Recommendations and NotesCollaboratively Based Recommended Strategies
Medications 
Skipping medications, waiting too long to take medications, not having medications available as needed 
  • ▪ Engage client in decision-making exercises to increase awareness of and education on early migraine triggers and symptoms.

  • ▪ Identify common barriers to medication adherence and having medications present as needed.

 
  • ▪ Implement medication management strategy, such as a pill organizer or apps to track medications.

  • ▪ Take acute medications as soon as symptoms arise.

 
Comorbidities
All comorbidities: mild traumatic brain injury, asthma, fibromyalgia, insomnia, chronic arthritis in neck, prediabetes 
Fibromyalgia, common cold, effects of seasonal allergies 
  • ▪ Address assertive communication and advocacy in health care settings to manage risk factors.

  • ▪ Short-term environmental temperature drops are a reliable migraine trigger; teach client to monitor upcoming weather changes (see environmental strategies).

 
  • ▪ Decrease sensory exposures (listed below) and reduce exercise when experiencing symptoms.

  • ▪ Pay especially high attention to all risk factors during March or November.

 
Sensory Exposure
All other risk factors exacerbate the effect of sensory exposure. 
Visual 
  • ▪ Recommend regular eye exams.

  • ▪ Engage client in tracking time use to identify current activity tolerance and behavior patterns around taking breaks.

 
  • ▪ Minimize television viewing.

  • ▪ Take frequent breaks and use proper lighting when using computer.

  • ▪ Use proper eyewear with the appropriate prescription as needed.

 
Auditory 
  • ▪ Engage in problem solving and planning to anticipate contexts when client may be exposed to auditory triggers.

  • ▪ Practice role-playing assertive communication to express sensory needs and requests.

 
  • ▪ Avoid noisy environments (e.g., loud parties, movie theaters).

  • ▪ Always maintain access to earplugs (keep in wallet).

  • ▪ Reduce time speaking with loud or fast talkers.

 
Environmental 
  • ▪ Provide education regarding the impact environmental factors have on managing chronic migraines.

  • ▪ Identify environmental factors that are in client’s control to inform action steps.

 
  • ▪ Wear hat and sunglasses when leaving home (keep extras in car).

  • ▪ Remain indoors on hot, sunny days.

  • ▪ Manage room temperature, track barometric pressure, and monitor weather changes.

 
Driving or riding in a car 
  • ▪ Vacations almost always induce migraines for this client.

  • ▪ Train client in seated body mechanics, adaptive equipment, and ergonomic supports for cars.

 
  • ▪ Avoid driving long distances.

  • ▪ Take frequent driving breaks.

  • ▪ Drive at night when possible.

 
Personal hygiene 
  • ▪ Provide education and training regarding proper body mechanics.

  • ▪ Provide education and training in activity pacing and energy conservation strategies.

 
  • ▪ Use proper body mechanics when engaging in activities of daily living such as hair washing or brushing teeth.

  • ▪ Create a weekly schedule to simplify and schedule personal hygiene tasks throughout the week to avoid triggering a migraine.

 
Physical Activity 
Lack of physical conditioning 
  • ▪ Exercise with precaution because of asthma and prior surgeries.

  • ▪ Client has a high baseline activity level, which makes avoiding overexertion challenging.

  • ▪ Physical activity is one of the client’s primary coping mechanisms.

 
  • ▪ Maintain physical fitness via running, stair machine, or moderate weight lifting.

  • ▪ Use headphones with music and record keeping to increase motivation to exercise.

 
Physical overexertion 
  • ▪ Reduce exercise during times when comorbidities are operative.

  • ▪ Develop varied exercise plans so that the client has physical activity options regardless of symptom presentation.

  • ▪ Introduce self-monitoring and symptom-tracking tools to increase awareness of activity thresholds for improved activity pacing.

 
  • ▪ Avoid highly strenuous exercise and activity.

  • ▪ Do not lift weights in the morning.

  • ▪ Refrain from spontaneous physically challenging activities (e.g., playing tag with daughter).

  • ▪ Avoid fast flurries of activity even when feel able.

  • ▪ Do not increase the amount or intensity of planned exercise too quickly.

 
Sleep Hygiene 
Too little sleep (<7 hr) 
  • ▪ In consultation with doctor, avoid all sleep medications, which elevate migraine risk for this client.

  • ▪ Instead, adhere to similar daily sleep and wake schedules, including weekends.

 
  • ▪ Adhere to a consistent, early bedtime.

  • ▪ Do not eat sugary food or large meals too close to bedtime.

  • ▪ Avoid screen time before sleep.

  • ▪ Turn off telephone at night and in the morning.

  • ▪ Use all other techniques for sleeping well.

 
Too much sleep (>9 hr) 
  • ▪ Adhere to similar daily sleep and wake schedules, including weekends.

 
  • ▪ Set alarm and establish morning routines to avoid excessive sleep.

  • ▪ Cut back on exercise and sensory exposure when sleeping too long.

 
Improper sleep positioning 
  • ▪ Educate client on sleep positioning for preferred position, appropriate supports, and ways to modify towels, blankets, and clothing if proper supports are not available.

 
  • ▪ Assess available pillows and support upon arrival, and request additional supports as needed.

 
Eating Routines and Diet 
Skipping meals or eating light meals 
  • ▪ Explore adequacy of overall nutritional intake with client.

  • ▪ Refer to dietitian as needed.

 
  • ▪ Ensure that high-protein food is readily available to eat when feeling weak, hungry, or faint.

  • ▪ Coordinate with family members who grocery shop to ensure availability of high-protein foods.

 
Avoid migraine-inducing foods 
  • ▪ Engage in tracking of food choices and migraines to identify patterns.

  • ▪ Determine whether client has been recommended an elimination diet to identify intolerances to specific foods.

 
  • ▪ Do not eat trigger foods (e.g., chocolate, nuts, aged foods).

  • ▪ Keep trigger foods out of house.

  • ▪ Minimize dining at restaurants or view menus ahead of time.

 
Stress
Client strengths to combat stress: strong spiritual orientation, positive life outlook, loves to sing 
Professional stressors (periods of high work volume) 
  • ▪ Client has difficulty with boundary setting in work and professional life (i.e., reasonable and necessary accommodations, assertive communication).

  • ▪ Use self-advocacy strategies.

  • ▪ Client has poor time awareness and difficulty estimating how long tasks take to complete and planning and scheduling appropriately.

  • ▪ Conduct ergonomic evaluation of workspace and environment to ensure appropriate fit.

 
  • ▪ Start all work early to avoid last-minute scrambling.

  • ▪ Take frequent breaks during work sessions.

  • ▪ Remember to exercise during periods of heavy work.

  • ▪ Submit reasonable and necessary workplace accommodation requests to human resources to improve migraine management in the workplace.

 
Personal stressors (caregiving and interpersonal relationships) 
  • ▪ Client provides care for an adult with a developmental disability.

  • ▪ Client reports long-standing interpersonal conflicts in familial relationships.

  • ▪ Address assertive communication strategies in personal relationships.

  • ▪ Review stress symptom inventory and identify specific triggers.

 
  • ▪ Access outside caregiving help.

  • ▪ Silence phone when relaxing to avoid unpleasant phone conversations.

  • ▪ Consider ways to forge more positive relationships with family members.

  • ▪ Exercise as soon as possible after experiencing a stressful situation.

  • ▪ Practice relaxation and breathing techniques.

 
Secondary Preventive Strategies 
Migraine prodrome or threat of migraine 
  • ▪ Encourage client to continue engaging in self-monitoring routines when traveling.

 
  • ▪ Increase rest time.

  • ▪ Temporarily restrict risk-inducing occupations (e.g., television, driving).

 
Relapse due to ongoing migraine 
  • ▪ Client has ability to carefully monitor bodily states for internal signs of migraine risk as a result of experiencing >700 prior attacks; integrate this strength into personal action plan.

 
  • ▪ Reframe the challenges of ongoing migraines with positive thinking.

  • ▪ Soak hands in hot sink water to minimize vasoconstriction with rebounding.

 
Migraine Risk FactorsClinical Recommendations and NotesCollaboratively Based Recommended Strategies
Medications 
Skipping medications, waiting too long to take medications, not having medications available as needed 
  • ▪ Engage client in decision-making exercises to increase awareness of and education on early migraine triggers and symptoms.

  • ▪ Identify common barriers to medication adherence and having medications present as needed.

 
  • ▪ Implement medication management strategy, such as a pill organizer or apps to track medications.

  • ▪ Take acute medications as soon as symptoms arise.

 
Comorbidities
All comorbidities: mild traumatic brain injury, asthma, fibromyalgia, insomnia, chronic arthritis in neck, prediabetes 
Fibromyalgia, common cold, effects of seasonal allergies 
  • ▪ Address assertive communication and advocacy in health care settings to manage risk factors.

  • ▪ Short-term environmental temperature drops are a reliable migraine trigger; teach client to monitor upcoming weather changes (see environmental strategies).

 
  • ▪ Decrease sensory exposures (listed below) and reduce exercise when experiencing symptoms.

  • ▪ Pay especially high attention to all risk factors during March or November.

 
Sensory Exposure
All other risk factors exacerbate the effect of sensory exposure. 
Visual 
  • ▪ Recommend regular eye exams.

  • ▪ Engage client in tracking time use to identify current activity tolerance and behavior patterns around taking breaks.

 
  • ▪ Minimize television viewing.

  • ▪ Take frequent breaks and use proper lighting when using computer.

  • ▪ Use proper eyewear with the appropriate prescription as needed.

 
Auditory 
  • ▪ Engage in problem solving and planning to anticipate contexts when client may be exposed to auditory triggers.

  • ▪ Practice role-playing assertive communication to express sensory needs and requests.

 
  • ▪ Avoid noisy environments (e.g., loud parties, movie theaters).

  • ▪ Always maintain access to earplugs (keep in wallet).

  • ▪ Reduce time speaking with loud or fast talkers.

 
Environmental 
  • ▪ Provide education regarding the impact environmental factors have on managing chronic migraines.

  • ▪ Identify environmental factors that are in client’s control to inform action steps.

 
  • ▪ Wear hat and sunglasses when leaving home (keep extras in car).

  • ▪ Remain indoors on hot, sunny days.

  • ▪ Manage room temperature, track barometric pressure, and monitor weather changes.

 
Driving or riding in a car 
  • ▪ Vacations almost always induce migraines for this client.

  • ▪ Train client in seated body mechanics, adaptive equipment, and ergonomic supports for cars.

 
  • ▪ Avoid driving long distances.

  • ▪ Take frequent driving breaks.

  • ▪ Drive at night when possible.

 
Personal hygiene 
  • ▪ Provide education and training regarding proper body mechanics.

  • ▪ Provide education and training in activity pacing and energy conservation strategies.

 
  • ▪ Use proper body mechanics when engaging in activities of daily living such as hair washing or brushing teeth.

  • ▪ Create a weekly schedule to simplify and schedule personal hygiene tasks throughout the week to avoid triggering a migraine.

 
Physical Activity 
Lack of physical conditioning 
  • ▪ Exercise with precaution because of asthma and prior surgeries.

  • ▪ Client has a high baseline activity level, which makes avoiding overexertion challenging.

  • ▪ Physical activity is one of the client’s primary coping mechanisms.

 
  • ▪ Maintain physical fitness via running, stair machine, or moderate weight lifting.

  • ▪ Use headphones with music and record keeping to increase motivation to exercise.

 
Physical overexertion 
  • ▪ Reduce exercise during times when comorbidities are operative.

  • ▪ Develop varied exercise plans so that the client has physical activity options regardless of symptom presentation.

  • ▪ Introduce self-monitoring and symptom-tracking tools to increase awareness of activity thresholds for improved activity pacing.

 
  • ▪ Avoid highly strenuous exercise and activity.

  • ▪ Do not lift weights in the morning.

  • ▪ Refrain from spontaneous physically challenging activities (e.g., playing tag with daughter).

  • ▪ Avoid fast flurries of activity even when feel able.

  • ▪ Do not increase the amount or intensity of planned exercise too quickly.

 
Sleep Hygiene 
Too little sleep (<7 hr) 
  • ▪ In consultation with doctor, avoid all sleep medications, which elevate migraine risk for this client.

  • ▪ Instead, adhere to similar daily sleep and wake schedules, including weekends.

 
  • ▪ Adhere to a consistent, early bedtime.

  • ▪ Do not eat sugary food or large meals too close to bedtime.

  • ▪ Avoid screen time before sleep.

  • ▪ Turn off telephone at night and in the morning.

  • ▪ Use all other techniques for sleeping well.

 
Too much sleep (>9 hr) 
  • ▪ Adhere to similar daily sleep and wake schedules, including weekends.

 
  • ▪ Set alarm and establish morning routines to avoid excessive sleep.

  • ▪ Cut back on exercise and sensory exposure when sleeping too long.

 
Improper sleep positioning 
  • ▪ Educate client on sleep positioning for preferred position, appropriate supports, and ways to modify towels, blankets, and clothing if proper supports are not available.

 
  • ▪ Assess available pillows and support upon arrival, and request additional supports as needed.

 
Eating Routines and Diet 
Skipping meals or eating light meals 
  • ▪ Explore adequacy of overall nutritional intake with client.

  • ▪ Refer to dietitian as needed.

 
  • ▪ Ensure that high-protein food is readily available to eat when feeling weak, hungry, or faint.

  • ▪ Coordinate with family members who grocery shop to ensure availability of high-protein foods.

 
Avoid migraine-inducing foods 
  • ▪ Engage in tracking of food choices and migraines to identify patterns.

  • ▪ Determine whether client has been recommended an elimination diet to identify intolerances to specific foods.

 
  • ▪ Do not eat trigger foods (e.g., chocolate, nuts, aged foods).

  • ▪ Keep trigger foods out of house.

  • ▪ Minimize dining at restaurants or view menus ahead of time.

 
Stress
Client strengths to combat stress: strong spiritual orientation, positive life outlook, loves to sing 
Professional stressors (periods of high work volume) 
  • ▪ Client has difficulty with boundary setting in work and professional life (i.e., reasonable and necessary accommodations, assertive communication).

  • ▪ Use self-advocacy strategies.

  • ▪ Client has poor time awareness and difficulty estimating how long tasks take to complete and planning and scheduling appropriately.

  • ▪ Conduct ergonomic evaluation of workspace and environment to ensure appropriate fit.

 
  • ▪ Start all work early to avoid last-minute scrambling.

  • ▪ Take frequent breaks during work sessions.

  • ▪ Remember to exercise during periods of heavy work.

  • ▪ Submit reasonable and necessary workplace accommodation requests to human resources to improve migraine management in the workplace.

 
Personal stressors (caregiving and interpersonal relationships) 
  • ▪ Client provides care for an adult with a developmental disability.

  • ▪ Client reports long-standing interpersonal conflicts in familial relationships.

  • ▪ Address assertive communication strategies in personal relationships.

  • ▪ Review stress symptom inventory and identify specific triggers.

 
  • ▪ Access outside caregiving help.

  • ▪ Silence phone when relaxing to avoid unpleasant phone conversations.

  • ▪ Consider ways to forge more positive relationships with family members.

  • ▪ Exercise as soon as possible after experiencing a stressful situation.

  • ▪ Practice relaxation and breathing techniques.

 
Secondary Preventive Strategies 
Migraine prodrome or threat of migraine 
  • ▪ Encourage client to continue engaging in self-monitoring routines when traveling.

 
  • ▪ Increase rest time.

  • ▪ Temporarily restrict risk-inducing occupations (e.g., television, driving).

 
Relapse due to ongoing migraine 
  • ▪ Client has ability to carefully monitor bodily states for internal signs of migraine risk as a result of experiencing >700 prior attacks; integrate this strength into personal action plan.

 
  • ▪ Reframe the challenges of ongoing migraines with positive thinking.

  • ▪ Soak hands in hot sink water to minimize vasoconstriction with rebounding.

 
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