Introduction
The patient is a 14-year-old girl, Julia, who visits a doctor with her mother. Julia describes her health as good. She is well-groomed, and her appearance corresponds with her age. She is not very communicative, but she is ready to answer all questions and explain her complaints. At the beginning of the conversation, she admits that her main complaint is her headache that could last for days. The mother sees the computer and the phone as the main reasons for why Julia has a headache. The girl spends much time using these technologies. In her turn, Julia admits that she used her computer and phone as an opportunity to distract her from pain. No similar cases have been observed before. She is a good student. She lives in a good family the members of which do not have any health problems. She does not have any other complaints and behaves normally in regards to the kind of pain she has.
Further Questions for Julia
- Do you observe a headache from the early morning?
- What methods have you tried to fall asleep?
- Have you recently survived some accidents or situations that made you upset, nervous, or anxious? (insomnia and PTSD)
- How often do you observe your sleeping problems?
- Do you have a headache when you sleep well?
- How long does a headache last? (migraine and PTSD)
- Do you feel vomiting or nauseous? (migraine and PTSD)
- What kind of a headache do you experience? (migraine)
- Do you have some sensitivity to light? (migraine)
- What is the location of your headache? (migraine)
- Do you have nightmares? (PTSD and insomnia)
- Do you use some pain reliefs? (PTSD)
- Have you ever visited a psychiatrist? (PTSD)
Differential Diagnoses
- Insomnia (G47.0): is the disorder that is characterized by some difficulties in falling asleep and sleeping at nights, and the adolescents are at high risk of having insomnia problems (Roberts & Duong, 2013, p. 66). The relations between a headache and insomnia have been reviewed by a number of researchers, and it was proved that sleeping problems could be the reason for why people suffer from headaches that could last for days (Tran & Spierings, 2013, p. 168; Uhlig, Engstom, Odegard, Hagen, & Sand, 2014, p. 746). The patient suffers from a headache and admits that she could not sleep well. She spends only 5-6 hours on sleep. Julia explains such short period of sleep by the inability to fall asleep as soon as it is required. She spends much time in front of her computer and phone.
- Migraine, unspecified, not intractable, without status migrainosus (G43.909): is a type of a headache disorder that is usually characterized by the tension-type headache (Balottin, Poli, Termine, Molteni, & Galli, 2012, p. 112). The symptoms of migraine cannot be defined as specific, and even experts have some difficulties in diagnosing it (Evans, 2015, p. 313). They could include mood changes, frequent urination, and sleep problems. A headache is a significant symptom of migraine that cannot be neglected. Migraine is usually identified as a certain type of pain a person could experience in their head. Julia underlines her constant headache and the inabilities to sleep well during the last days. Still, the examination does not introduce a clear picture of why migraine could influence Julia in that way. The reason for why she has a headache could be explained by a frequent usage of her computer and phone.
- Post-Traumatic Stress Disorder (F43.1): is a type of traumatic stress disorders the symptoms of which could be identified during the next several months. It is a complex disorder that could change human social and educational functioning considerably (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012, p. 122). Sometimes, adolescents do not want to talk about the situations that could lead to PTSD even with their parents. Therefore, the situation Julia has could be interpreted in a number of ways. The impossibility to answer what makes her sleep badly and suffer from a headache could be connected with some events recently experienced. Besides, it is necessary to clarify why Julia wants to change real life communication to phone and computer activities.
Body Systems to Examine
Three differential diagnoses have several systems that could undergo some abnormalities in common.
Immune system – insomnia (sleep influences human process memories, metabolism, and healing processes).
Circulatory system: migraine (strokes could be caused by the frequent constriction of blood vessels).
Nervous system: PTSD (brain problems that could lead to certain neurochemical changes that could be observed with the help of special technologies only).
Specific Lad/Testing To Offer
Julia could be suggested to take two types of tests to clarify if there are additional symptoms in her body system that could prove/disprove the differential diagnoses offered. For example, it is possible to take:
- Blood tests are used to analyze the count of blood cells, the level of immunoglobulin, and lymphocyte count (Nagai, Hoshide, Nishikawa, Shimada, & Kario, 2013, p. 984).
- ECG should help to discover the nature of heart problems caused by migraine (Del Torre, Pellegrinet, Motz, Sechi, & Cavarape, 2015).
References
Balottin, U., Poli, P. F., Termine, C., Molteni, S. and Galli, F. (2012). Psychopathological symptoms in child and adolescent migraine and tension-type headache: A meta-analysis. Cephalalgia, 33(2), pp.112-122.
Del Torre, M., Pellegrinet, M., Motz, E., Sechi, L.A., & Cavarape, A. (2015). QT prolongation during a migraine attack.Journal of Neurology and Neuroscience. Web.
Evans, R.W. (2015). Migraine mimics. Headache, 55(2): 313-322.
Nagai, M., Hoshide, S., Nishikawa, M., Shimada, K., & Kario, K. (2013). Sleep duration and insomnia in the elderly: Associations with blood pressure variability and carotid artery remodeling. American Journal of Hypertension, 26(8), 981-989.
Roberts, R. E., & Duong, H. T. (2013). Depression and insomnia among adolescents: A prospective perspective. Journal of Affective Disorders,148(1), 66-71.
Tran, D. P., & Spierings, E. L. (2013). Headache and insomnia: Their relation reviewed. CRANIO®, 31(3), 165-170.
Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32(2), 122-138.
Uhlig, B. L., Engstrom, M., Odegard, S. S., Hagen, K. K., & Sand, T. (2014). Headache and insomnia in population-based epidemiological studies. Cephalalgia, 34(10), 745-751.