Patient Diagnosis Case Study: Migraine
Based on the knowledge you have gained up to this point, it is time to apply your skills to complete a case study for a patient presenting with a migraine.
Read the patient scenario and answer the following questions.
A 34-year-old female patient presents to your primary care clinic and complains of a headache.
Note: You have two attempts. You can choose to just do it all on one attempt. However, because it is a case study, go in the first time and copy down the questions and answers work on it, then go back in later on your second attempt and answer the questions. Do not put in any answers on your first attempt. You should receive a 0. This should not be an opportunity to play with the correct or wrong answers. If you put in answers on the first attempt (or get a score other than 0) I will count this as your attempt.
Question 1As you consider potential diagnoses, select all options that are not considered to be possible serious and/or life-threatening etiologies.
Giant Cell/Temporal Arteritis
Cerebrovascular Disease (AVM)
Primary Migraine Dysfunction Disorder (PMDD)
Question 2What is a possible cause for Cluster type headaches? Choose the best answer.
Occipital and/or Trigeminal Neuralgia
Trigeminal and Hemicrania Neuralgia
Overactivation of the Vagus and Occipital Nerve
Question 3You realize that you would like to evaluate this patient further for any “Red Flags.” Which of the following questions would not be appropriate to ask in the context of red flags? Select all that apply.
Is this your first/worst headache or is this different than previously?
Have you had any fever or weight loss?
Did it occur suddenly? (thunderclap)
Have you noticed difficulty moving your extremities or difficulty with speech or vision?
Have you had any nausea or vomiting?
Does this occur on both sides of your head?
Have you had recent trauma or injury?
Did your first headache occur before you were 30 years old?
Question 4You have determined that there are no redflags and want to better characterize her chief complaint. She states that her headaches are usually unilateral and can throb. She thinks she gets headaches about 15-18 days a month and they tend to last 1-2 days each episode. She appears to most likely be experiencing:
Atypical tension type headaches
Uncomplicated cluster type headache
A slow brain bleed (subarachnoid hemorrhage)
Menstrual headaches with migraine feature
Question 5Before you discuss treatment, you decide you want to explore her symptoms and condition a bit further now that you have an idea about the diagnosis. You would ask all the following relevant questions except:
Do you have associated nausea/vomiting?
Have you missed any work or had limited ability to perform ADL’s due to this?
Do you have photophobia?
What remedies have you tried to make this better?
Do you have low back pain?
Do you notice worsening symptoms during or around menstruation?
Question 6Now that the patient’s condition is evaluated you begin to consider treatment options and recommendations. As a part of this,you will need to provide the patient with the following education during the visit. Which statements should not be included? Select all that apply.
You appear to be suffering from migraine syndrome and this is a chronic disease.
NSAID have been shown to provide benefit in improving attacks, take as much as you need.
There could be multiple triggers which you can try to minimize, such as avoiding certain foods.
Adequate sleep is important.
It may be possible to reduce or prevent your headaches with treatment.
Antidepressants probably won’t help at all.
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Patient Diagnosis Case Study: Migraine