Discuss the questions that would be important to include when interviewing a patient with this issue
Headaches disorders are usually diagnosed based on the interviews or questionnaires about the history of the patient. The questions should focus on different types of primary and secondary headache types (Karakurt, Whiting, Esch, Bolen, & Calabrese, 2016). The list would include the following:
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- When did the headaches start?
- How many headache attacks per day does the patient have and how long do they last?
- Was there any change in the character of the headache? If yes, what kind?
- Are there any factors that trigger headaches, such as alcohol, menstruation, stress, fatigue, missing meals, caffeine, or change in the weather?
- How would Ms. Davis assess her typical headache on the line from 1 to 10, where 1 is minimal pain, and 10 is unbearable pain?
- Is there any pattern to the headaches? Do they happen at a particular time of the day or on certain days of the week or month?
- Are there any warning signs of a coming headache?
- Are there any additional symptoms such as nasal congestion, diarrhea, nausea, vomiting, visual changes, photophobia, phonophobia, extreme thirst, speech disturbance, vertigo, or loss of balance?
- Does Ms. Davis have insomnia?
- Does the patient consider herself under stress?
- Does she have a regular sleeping and eating pattern?
- Has the patient experienced any trauma?
- What kind of medicine is she taking or used to take in the previous two months, including herbs, birth-control peals, and antidepressants?
- Is she pregnant?
- Does the patient have any family history of migraines?
- Does she have any history of snoring, lung disease, anemia, hypertension, motion sickness, or cigarette smoking?
Describe the clinical findings that may be present in a patient with this issue
Ms. Davis appears to have the apparent signs of intimate partner violence (IPV). First, the patient reports incidents of her being the victim of her boyfriend’s abuse. Second, she has bruises with different age that are noted during her physical exam. Third, the woman shows signs of fear and unsafety as she fails to maintain eye contact while being examined and interviewed. Therefore, her headache appears to be provoked by stress and depression from the IPV.
IPV is usually associated with headaches, pains in the back, sexually transmitted diseases (STDs), digestive problems, and depression. As the woman can be a victim of verbal abuse, humiliation, social isolation, and threats of violence or financial deprivation, she may experience low self-esteem, loneliness, hopelessness, and physical pain (Jack, Ford-Gilboe, Davidov, & MacMillan, 2016). Moreover, the woman may have gynecologic problems or issues with her central nervous system. Women diagnosed with IPV can also be pregnant with an unwanted baby or suffer from the consequences of miscarriage or abortion (Jack et al., 2016). Hence, Ms. Davis can be expected to have some or all of the symptoms mentioned above.
Are there any diagnostic studies that should be ordered on this patient? Why?
There are no specific tests for IPV; however, some diagnostic studies should be ordered to test for accompanying symptoms. First, as Ms. Davis is of childbearing age, a pregnancy test should be made. Pregnancy can be a decisive factor for diagnosis and treatment; therefore, before prescribing any medicine, every doctor and nurse practitioner should run the examination. Second, tests of blood, urine, and genital secretion should be taken to rule out sexually transmitted diseases including HIV. Third, in some cases, a genital examination may be beneficial, as IPV victims often have gynecologic problems (Jack et al., 2016). Finally, if further aggravation of headaches follows without an apparent reason, a CAT scan should be made to rule out brain injury or cancer. In short, all the studies should be aimed at associated problems rather than at IPV.
List the primary diagnosis and three differential diagnoses for this patient. Explain your reasoning for each
The primary diagnosis for Ms. Davis’s case is the intimate partner violence. According to the history taken from the patient, the woman is currently unemployed and financially dependent on her boyfriend, who is occasionally physically, morally, and sexually abusive towards the patient. Moreover, Ms. Davis shows signs of fear to address the behavior of her boyfriend, as she did not take any pamphlets and refused to get help from social workers. Additionally, as the headaches are recurrent with no obvious pattern, it is clear that outside factors can be the reason for them. Therefore, the most likely diagnosis for MS. Davis is the IPV; however, other possibilities should be stated to avoid being biased.
The other diagnosis for the patient may be a tension headache. According to Turner et al. (2015), a tension headache is the most common type the primary symptom of which is dull head pain. Such pains are periodic and happen one-two times a month and often associated with emotional stress. Ms. Davis was admitted to the emergency department with a dull headache unaccompanied by nausea, vomiting, visual disturbance, or other neurologic abnormalities. As she was a victim of IPV, she can be perceived to have emotional stress. Therefore, the patient shows all the signs of the tension-type headache; however, the data set is narrow and additional examinations should be made to rule out other possibilities for the diagnosis.
Among less possible variants, migraine should be considered as a viable diagnosis. Migraines are more frequent in women than in men and are characterized by recurrent headaches in one side of the head (Turner et al., 2015). At the same time, the illness is usually accompanied by aura, nausea, vomiting, and photophobia. Therefore, although Ms. Davis has some signs that point at migraine headaches, she does not seem to have other essential symptoms for the diagnosis.
Even though Ms. Davis does not have a history of trauma, a concussion can be the fourth and the least possible variant of her condition. Concussions are usually accompanied by nausea and vomiting, the signs of which are not found in the patient’s case record. However, Ms. Davis reports the cases of her boyfriend physically abusing her, and her head may have been hit and her brain damaged during one of the fights with her boyfriend. Therefore, a concussion can become the explanation for the patient’s headaches, although a CAT scan is needed to confirm the diagnosis.
Discuss your management plan for this patient, including pharmacologic therapies, tests, patient education, referrals, and follow-ups
My management plan would be centered on counseling and education about IPV. According to Karakurt et al. (2016), a couples therapy can be effective in this case for reducing violence in the relationship. At the same time, I would not insist on the treatment, as patients should be allowed to dictate the plan based on their view of what is safest for them. I would refer the patient to visit a gynecologist and a psychiatrist.
I would recommend continuing courses of acetaminophen and ibuprofen, as the medications have proven to be helpful for the patient’s condition. Additionally, I would suggest avoidance of headache triggers and educate the patient about relaxation technics, such as meditation, acupuncture, and massage. In conclusion, IPV is a prevalent problem that has adverse effects on the well-being of adults and children that witness it. It should be treated with due attention and delicacy, as it can be a severe threat to a patient’s health and life.
Jack, S., Ford-Gilboe, M., Davidov, D., & MacMillan, H. (2016). Identification and assessment of intimate partner violence in nurse home visitation. Journal of Clinical Nursing, 26(15-16), 2215-2228. Web.
Karakurt, G., Whiting, K., van Esch, C., Bolen, S., & Calabrese, J. (2016). Couples therapy for intimate partner violence: A systematic review and meta-analysis. Journal of Marital and Family Therapy, 42(4), 567-583. Web.
Turner, D., Smitherman, T., Black, A., Penzien, D., Porter, J., Lofland, K., & Houle, T. (2015). Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache. PAIN, 156(7), 1200-1207. Web.