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LETTERS

Ramey, Ruby BSN, RN, FNP; Renjith, Vishnu MSN, RN; George, Anice PHD, RN

doi: 10.1097/01.NURSE.0000458929.56586.55
Department: LETTERS
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Trust a nurse's intuition...keeping a diary helps patients manage migraines

Newland, N.C.

Udupi, Karnataka, India

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Trust a nurse's intuition

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> “Crying Wolf or the Real Deal?” (Sharing, November 2014)* really hit home with me. I'm a nurse and can sympathize with overworked colleagues caring for patients. On the other hand, I lost my best friend when the staff thought she was “crying wolf.” Hospitalized with an acute asthma exacerbation, she was very anxious and frequently used the call bell. When she was in severe respiratory distress the staff was slow to respond, which caused her to live in a vegetative state for 3 years. I'm not blaming the nurses, or my friend, it was just one of those very sad healthcare cases.

The article also reminded me of when I was a new nurse in 1968 doing private duty for a postoperative patient. The second night she just didn't seem right to me. I called the physician, but couldn't give him any specifics, just my intuition. He ignored my concerns. The next day the patient died from a pulmonary embolism. The doctor apologized and said he'd never again ignore a nurse's concerns.

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Diaries help patients manage migraines

> Thank you for publishing “Patient Education Series: Migraine Headache” (August 2014).* There's no miraculous cure for migraine headache, but people suffering from them can do a lot to prevent attacks. Migraine headaches can be well controlled by following the simple steps mentioned in the article. We'd like to add the importance of keeping a migraine diary. By maintaining a diary, a migraineur can look for trends in his or her headache pattern.

As a part of our research work, we've developed a comprehensive migraine diary consisting of eight parts: migraine occurrence, duration, pain intensity, perceived disability (mild, moderate, or severe), trigger, symptoms, medication use (type and dose), and relief (complete, moderate, or none). Patients are instructed to record the details of each migraine attack in their diary to track features of each attack, which helps improve nurse-patient communication, tapering and tailoring of pharmacologic therapy, and treatment efficacy.

Because migraines often follow a pattern, maintaining an accurate migraine diary helps the healthcare provider identify the pattern over time. This aids in planning a need-based, tailored intervention for better control of debilitating migraine headaches. We found that maintaining the diary also improves the personal comfort and eases the emotional stress of migraineurs.

—RUBY RAMEY, BSN, RN, FNP

Newland, N.C.

—VISHNU RENJITH, MSN, RN, AND ANICE GEORGE, PHD, RN

Udupi, Karnataka, India

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