The Patient
In this case, we have a thirty years old female of Asian origin who has a history of headache when she was in her teen years. In the recent past, the headache has become increasingly deliberating marked by a sharp pain that worsens with light and comes with nausea and vomiting at times. The pain is 7/10 on the rating scale and shows no remarkable signs upon a VS WNL physical exam. She often takes two tabs of OTC Motrin and sleeps in a darkened room to relieve the headache.
Diagnosis
The primary diagnosis for this patient is migraine headaches. A migraine often results in the extreme throbbing pain that at times, is accompanied by a pulsing sensation on mainly one side of the head. Usually, migraine comes along with vomiting, nausea and high sensitivity to sound and light. These are symptoms present in the patient (Weatherall, 2015) . In some individual, it is common for an aura to come as a warning of the severe headache. Migraine headaches are related to specific changes within the brain of an individual.
Delegate your assignment to our experts and they will do the rest.
Migraine attacks are triggered by several factors, including stress, certain foods, loud music, light, and hormonal changes, among other factors. An aura is a disturbance of an individual's vision that comes in the form of light flashes, blind spots and other features such as tingling sensation on the face, arm, leg or moth that may make it hard to speak (Weatherall, 2015) . With migraine attacks often lasting for hours to even days, there is often an interruption of the typical daily activities that the individual carries out.
Differential Diagnosis
One possible cause for the pain is tension headaches. A tension headache involves pain that is accompanied by a feeling of a tight band around the head. Tension headache does not affect vision or cause nausea or vomiting as in the case (Jensen, 2018) . Tension headaches also tend to be diffuse and mild to moderate. The patient, in this case, has sharp pain instead of diffuse.
Just like migraines, cluster headaches often occur on one side of the head. Also, sensitivity to light and sounds is common with people with cluster headaches. However, unlike migraines, cluster headaches may cause the individual to pace or sit and rock back and forth due to restlessness. Other common symptoms in cluster headache include excessive tearing, running or stuffy nose, eye redness, sweating and pale skin ( Jensen, 2018) . These symptoms lack in the patient. Also, cluster headaches do not cause vomiting and nausea-like the patient in the case.
Sinusitis is another possible cause of the challenge facing the patient. Referring to the inflammation of tissues that line sinuses, sinusitis also causes headaches. Sinusitis is mainly caused by common cold, nasal polyps, allergic rhinitis and deviated septum. Apart from headache, sinusitis comes along with a running nose, fatigue, fever and congestion ( DeMuri et al., 2019) . While it may react to light, the patient lacks other symptoms that could allow for relating the headache with sinusitis.
The relevance of the Patient History and Physical Exam
The key to understanding the challenge with the patient relies on their history. Medical history provides an opportunity for a physician to adequately understand the challenge facing the patient, including the level and type of pain. Headaches are especially challenging to determine since they lack outward signs and laboratory tests (Becker, 2017) . In this case, the patient is not clear on the type of headache, leaving the physician to decide between the four types. However, upon further enquiry, we see additional information such as nausea and vomiting that allows the physician to determine that presence of migraine. Understanding of duration, pain character, associated symptoms, and aggravating and relieving factors will enable the physician to arrive at this diagnosis.
Physical exam is also vital in the determination and diagnosis of the patient in the case. Where there lack any outward signs of headache that could be used to determine the type, a physical examination is essential for eliminating specific possible causes of the challenge (Becker, 2017) . It is only after physical examination that one can determine the absence of sinusitis. If the headache were as a result of sinusitis, then specific symptoms such as a running nose and fever would accompany the problem.
Treatment
Both pharmacological and non-pharmacological methods are used in the treatment of migraine headaches. Weatherall (2015) recommends a combination of different approaches for the treatment of migraines. Often, a neurological examination is required on top of the patient history before treating for migraines. Some of the tests that can be run to understand migraines better include an MRI scan for the identification of tumours or other challenges in the brain, or a CT scan. Often, the doctor will give either pain reliving or preventive medication for patients with migraines.
In this case, I think medication for relieving pain should be used to treat the migraine headaches in the patient. Simple pain relievers are best suited for this patient to eliminate symptoms whenever they occur. Aspirin, paracetamol and ibuprofen could be used to relieve pain in the patient and reduce the risk of other complications (Loder, Sheikh & Loder, 2015) . Additionally, anti-nausea drugs are necessary to reduce nausea and vomiting in the patient. Such drugs include metoclopramide, chlorpromazine and prochlorperazine.
References
Becker, W. J. (2017). The diagnosis and management of chronic migraine in primary care. Headache: The Journal of Head and Face Pain , 57 (9), 1471-1481.
DeMuri, G. P., Eickhoff, J. C., Gern, J. C., & Wald, E. R. (2019). Clinical and Virological Characteristics of Acute Sinusitis in Children. Clinical Infectious Diseases .
Jensen, R. H. (2018). Tension ‐ Type Headache – The Normal and Most Prevalent Headache. Headache: The Journal of Head and Face Pain , 58 (2), 339-345.
Loder, S., Sheikh, H. U., & Loder, E. (2015). The prevalence, burden, and treatment of severe, frequent, and migraine headaches in US minority populations: statistics from National Survey studies. Headache: The Journal of Head and Face Pain , 55 (2), 214-228.
Weatherall, M. W. (2015). The diagnosis and treatment of chronic migraine. Therapeutic advances in chronic disease , 6 (3), 115-123.
