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Neurological & Male Genitourinary Disorders

 25year old, Hispanic female with a chief complaint of right temporal headaches with nausea.  No vomiting.  Headaches do improve with rest and sleeping. 

What other subjective data would you obtain?

 Data that has already been provided is that a right temporal headache that gets worse with light.  Patient explains she experiences frequent headaches with menses.  Does the patient have a family history?  Can she identify any triggers? Additional questions that should be asked are related to the pain she is experiencing.  On a pain scale of 0-10, how would she rate the pain? How long does the pain last without rest? Does the pain radiate? Describe the pain; is it throbbing, pulsating or stabbing?  Patient takes ibuprofen for the headaches.  Does the medication help reduce the pain? If it does, what is the pain rate?

What other objective findings would you look for?

  Patient is wearing dark glasses in a dark room due to photophobia.  Migraine headaches cause intense, throbbing pain, often on one side of the head. Nausea, vomiting and sensitivity to light, sound and exertion often accompany migraines, which can last several hours or up to three days. Some migraine sufferers experience a visual disturbance called an aura prior to the onset of the migraine. Auras are flashing lights, wavy lines, blurry vision or blind spots (Radiological Society of North America (RSNA) and American College of Radiology (ACR), 2020).

What diagnostic exams do you want to order?

 Blood chemistry and urinalysis can rule out any other medical conditions such as dehydration, diabetes or thyroid disease. An MRI can be used to examine the anatomy of the brain and to assist in the diagnosis of tumors, developmental abnormalities, blood vessel problems and disorders of the eyes and the inner ear.  A CT scan can detect similar abnormalities.  A lumbar puncture also known as a spinal tap, this helps physicians diagnose infections such as meningitis, encephalitis or inflammatory conditions such as multiple sclerosis.

Name 3 differential diagnoses based on this patient presenting symptoms? Give rationales for each differential diagnosis.

 Primary headaches are the most common type of headaches, they are painful but not dangerous.  Secondary headaches are characterized by excruciating pain which are usually caused by another more serious condition.  Migraine is the most common form of headache, but not all headaches are migraines. The term “migraine” refers to a headache which is usually (but not always) on one side of the head. It is a headache that lasts from two to seventy-two hours, typically, and it is often associated with nausea and/or vomiting, sensitivity to light and/or sound. The character of the pain is typically a throbbing pain (Stanford Health Care, 2017).  Tension-type headache is most likely the second most common headache type after migraine. They are often referred to as “hatband” headaches because they typically painful around the back of the head, the temples and forehead, as if a tight hat were in place.  A cluster headache is a headache which is short lasting usually between 20 minutes and two hours. It is always one-sided and is associated with symptoms such as a stuffy nose on one side, tearing, an enlarged pupil, or a droopy lid.

References

Radiological Society of North America (RSNA) and American College of Radiology (ACR). (2020). Headaches: Migraines – Causes, Diagnostic Tests and Treatment. Retrieved November 26, 2020, from https://www.radiologyinfo.org/en/info.cfm?pg=headache (Links to an external site.)

Stanford Health Care. (2017, September 11). Migraine headache. Retrieved November 26, 2020, from https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/headache/types/migraine-headache.html

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