Reflecting on Patient Information
In the given case, a 30-year-old woman complains about headaches that were characteristic to her, yet they strengthened recently. The review of the patient history shows that she suffered from headaches from the very teenage, and her health condition is chronic. Consistent with Buttaro, Trybulski, Polgar Bailey, and Sandberg-Cook (2017), one may state that this is a primary headache that results from pathophysiologic mechanisms. The fact that the patient is light sensitive seems to be informative as the reduced headache in terms of the darkened room allows determining a proper diagnosis. More to the point, the additional symptoms such as nausea and vomiting also point to the primary diagnosis of migraine. The patient’s gender and age are considered among risk factors for developing the mentioned health condition (Vetvik & MacGregor, 2017). The physical examination reveals that vital signs are within limits, which eliminates meningitis and tumors.
Identifying Differential Diagnosis
- Migraine without aura. This chronic relapsing disease is characterized by sudden-onset attacks of intense pain in the head that are, more often, of a pulsating nature (Vetvik & MacGregor, 2017). During a migraine attack, patients have a high sensitivity to bright light, noise, and smells, and they experience nausea and vomiting. Since all of the above symptoms are present in the patient, it is possible to confidently state that the primary diagnosis is migraine.
- Cluster headache. This disease is marked by short attacks of severe unilateral headache that composes the area around the eye. This pain occurs for no apparent reason, once or several times a day, and at about the same time of the day or night (Buttaro et al., 2017). Cluster headache is so excruciating that the majority of patients has vivid motor excitation. A typical sign of the disease is the vegetative support of attacks expressed in lachrymation, reddening of the sclera, and nasal congestion.
- Tension-type headache. It is a two-sided diffuse headache with a compressive nature of a mild or moderate intensity (Freitag, 2013). In most cases, it is not accompanied by concomitant symptoms, but some patients may not tolerate bright light. The presence of other symptoms that were discussed above eliminates this diagnosis.
- Subarachnoid hemorrhage (SAH). This condition is caused by cerebral bleeding, in which blood accumulates in the subarachnoid space of the cerebral membranes (Verma et al., 2013). It is associated with intense and severe headache, short-term loss of consciousness and its confusion in combination with hyperthermia and meningeal symptoms.
Determining Treatment Options
The first-line treatment of patients suffering from migraine without aura can consist of addressing migraine attacks and preventing their future onset. Medication aimed at stopping headache (analgesics, antiemetics, triptans, or ergotamine-containing drugs) and their prevention (b-blockers or anticonvulsants) should be considered. Specifically to the given patient, triptans (Imitrex 50 mg daily) and analgesics (Excedrin 2 caplets per day) should be prescribed (Vetvik & MacGregor, 2017). The second-line treatment may involve beta-blockers (Atenolol 50mg daily) and Botox as a potential innovative option (Khalil, Zafar, Quarshie, & Ahmed, 2014). Non-medication methods may include psychotherapy, massage, or manual therapy. To reduce the severity of the headache during a migraine, the patient can rest for a few hours in a dark and quiet room. In most cases, the treatment of a patient suffering from migraine lies not only in the selection of medication. It is of great importance to normalize the regimen of the day, ensure sufficient sleep, apply methods of relieving nervous tension, and follow proper nutrition.
References
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Freitag, F. (2013). Managing and treating tension-type headache. Medical Clinics, 97(2), 281-292.
Khalil, M., Zafar, H. W., Quarshie, V., & Ahmed, F. (2014). Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; Real-life data in 254 patients from Hull, UK. The Journal of Headache and Pain, 15(1), 54-63.
Verma, R. K., Kottke, R., Andereggen, L., Weisstanner, C., Zubler, C., Gralla, J.,… Ozdoba, C. (2013). Detecting subarachnoid hemorrhage: Comparison of combined FLAIR/SWI versus CT. European Journal of Radiology, 82(9), 1539-1545.
Vetvik, K. G., & MacGregor, E. A. (2017). Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. The Lancet Neurology, 16(1), 76-87.