Case and Discussion: Headache
A 35-year-old woman comes to your office to discuss her “bad headaches,” which started after having her first child 2 years ago. The headaches sometimes awaken her from sleep and at times can be disabling and occasionally require her to take Tylenol and rest in a dark room. Sometimes she vomits during an attack. Over the past 6 months, her headaches have become more severe and frequent, prompting her visit today.
- What additional questions would you ask to learn more about her headaches?
- How do you classify headaches?
- How can you determine if this is an old headache or a new headache/s? Is this a chronic or episodic condition?
- Can you make a definite diagnosis through an open-ended history followed by focused questions?
- How can you use the patient history to distinguish between benign headaches and serious ones that require urgent attention?
- What diagnostic tests do you want to include to help you with your diagnosis?
- Create a differential diagnosis flow sheet for this patient for this patient and include the diagnostics related to the differentials.
INCLUDE 3 REFERENCES IN APA FORMAT
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Case and Discussion: Headache, health and medicine homework help Nursing Assignment Help
Introduction:
Headaches are a common complaint among individuals seeking medical attention. As a medical professor, in charge of creating assignments and answers for medical college students, addressing this case of a 35-year-old woman with severe headaches is an opportunity to explore the diagnostic and management aspects of this condition.
1. What additional questions would you ask to learn more about her headaches?
To gain further insight into the nature of the headaches, the following additional questions can be asked:
– What is the frequency and duration of the headaches?
– Can you describe the quality and location of the pain?
– Do the headaches have any triggering factors or associated symptoms?
– Have you experienced any recent changes in your lifestyle, stress levels, or diet?
– Are there any family history of headaches or other neurological disorders?
– Have you tried any medications for your headaches, and if so, what was the response?
2. How do you classify headaches?
Headaches can be classified into primary and secondary types. Primary headaches, such as tension-type headaches and migraines, occur independently and do not have an underlying cause. Secondary headaches result from an identifiable underlying condition, such as a head injury, infection, or medication side effects.
3. How can you determine if this is an old headache or a new headache/s? Is this a chronic or episodic condition?
Differentiating between old and new headaches can be established by determining the temporal relationship to specific events or triggers. In this case, the headaches started after the patient’s first child was born, suggesting a possible postpartum etiology. Chronic headaches refer to those occurring on 15 or more days per month for at least three months, whereas episodic headaches occur with less frequency.
4. Can you make a definite diagnosis through an open-ended history followed by focused questions?
An open-ended history allows patients to provide a comprehensive description of their headaches, while focused questions aim to gather specific details. Although an accurate diagnosis often requires additional diagnostic tests or a complete physical examination, a migraine or tension headache diagnosis can often be made through history alone.
5. How can you use the patient history to distinguish between benign headaches and serious ones that require urgent attention?
Several red flags in the patient’s history may indicate a need for further investigation or urgent attention. These include the sudden onset of severe headache, changes in headache characteristics, patterns, or associated neurological symptoms. A thorough history can help identify these warning signs.
6. What diagnostic tests do you want to include to help you with your diagnosis?
Diagnostic tests to consider based on the patient’s presentation may include:
– Laboratory tests: Complete blood count, metabolic panels, and erythrocyte sedimentation rate to evaluate for any underlying systemic cause.
– Neuroimaging: Magnetic resonance imaging (MRI) or computed tomography (CT) scan can be considered to rule out structural abnormalities and other intracranial pathologies.
7. Create a differential diagnosis flow sheet for this patient and include the diagnostics related to the differentials.
Differential Diagnosis Flow Sheet:
1. Migraine headache:
– Diagnosis based on characteristic features and absence of red flags.
– No specific diagnostic tests required.
2. Tension headache:
– Diagnosis based on identifying tension-type characteristics.
– No specific diagnostic tests required.
3. Cluster headache:
– Diagnosis based on episodic severe pain, usually on one side of the head.
– No specific diagnostic tests required.
4. Postpartum headache:
– Diagnosis based on temporal relationship to childbirth.
– Diagnostic tests may include a review of pediatric and obstetric records.
5. Intracranial pathology (e.g., tumor, hemorrhage):
– Consider neuroimaging (MRI or CT scan) to rule out structural abnormalities.
– Discuss with a neurologist for further evaluation.
References:
1. Headache Classification Committee of the International Headache Society (IHS). (2018). The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38(1), 1-211.
2. Buse, D. C., Rains, J. C., & Goadsby, P. J. (2012). Treatment of migraine. The Journal of the American Medical Association, 307(17), 1868-1875.
3. Loder, E., & Burch, R. (2018). The 2018 AHS/AAN guideline on the preventive treatment of migraine: A summary and comparison with other recent clinical practice guidelines. Headache: The Journal of Head and Face Pain, 58(2), 188-199.
