Patient Is A 24-Year-Old Female Administrative Assistant ✓ Solved

Patient Is A 24 Year Old Female Administrative Assistant Who

Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.

Paper For Above Instructions

The patient, a 24-year-old female administrative assistant, presents with a severe, right-sided headache, which she has experienced recurrently over the last two months. This recurrent headache may be indicative of several underlying issues, warranting a closer examination of potential diagnoses, appropriate management strategies, and further evaluations to elucidate the etiology of her condition.

1. Understanding the Symptoms

The patient reports that her headaches have lasted for a duration of 2-3 days and are accompanied by nausea and vomiting, with a pain intensity rating of 10 out of 10. These symptoms, particularly the photophobia ("the light hurts my eyes"), are critical in narrowing down possible causes.

The reoccurring nature of the headache, along with its debilitating intensity, suggests the possibility of a migraine or cluster headache, both of which can present with severe unilateral headaches and associated symptoms such as nausea and vomiting (Stovner et al., 2016). Moreover, a thorough understanding of the patient's headache history is necessary, such as triggers, associated aura, and familial headache patterns.

2. Possible Diagnoses

For this patient, the following diagnoses could be considered based on her presenting symptoms:

• Migraine Headaches: Given the symptoms of unilateral severe pain, nausea, vomiting, and photophobia, a migraine is highly likely. The International Classification of Headache Disorders defines migraines with these features (Headache Classification Committee, 2018).
• Tension-type Headaches: While less likely due to the severe nature of the pain and associated symptoms, tension-type headaches could still be a consideration (Bendtsen et al., 2016).
• Cluster Headaches: Characterized by severe unilateral pain and associated autonomic features, cluster headaches are a consideration, especially given their episodic nature (Goadsby et al., 2017).
• Secondary Headaches: The presence of nausea and vomiting may prompt an evaluation for secondary causes such as increased intracranial pressure, intracranial hemorrhage, or tumors, which must be ruled out (Schievink, 2015).

3. Diagnostic Workup

Given the severity and frequency of her headaches, a comprehensive diagnostic workup is warranted. This may include:

• Neurological Examination: A thorough assessment to identify any focal neurological deficits.
• Imaging Studies: Brain MRI or CT scan to exclude secondary causes such as tumors, intracranial hemorrhage, or structural abnormalities (Buchanan et al., 2016).
• Laboratory Tests: Basic metabolic panel and complete blood count to check for signs of infection or other systemic issues.
• Headache Diary: Asking the patient to keep a diary of her headaches may help identify patterns and triggers (Lindsay et al., 2019).

4. Management Strategies

Treatment for the patient's condition should focus on both acute management and preventive strategies:

• Acute Management: The use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is common; however, if these are insufficient, prescription medications like triptans may be effective for migraines (Bigal et al., 2008).
• Preventive Management: If migraines are confirmed and are having a significant impact on her daily life, preventive medications such as beta-blockers or anticonvulsants may need to be considered (Silberstein et al., 2012).
• Non-Pharmacological Interventions: Lifestyle modifications, including regular sleep, hydration, caffeine, and avoidance of known triggers, may also significantly reduce the frequency and severity of headaches (Friedman, 2019).

5. Patient Education

It is essential to educate the patient regarding her condition, emphasizing the significance of monitoring headache frequency, intensity, and associated symptoms. Providing a clear explanation of the treatment plan, potential side effects, and the importance of follow-up appointments to monitor her condition will empower the patient in managing her health (Buse et al., 2019).

Conclusion

In conclusion, this patient's recurrent right-sided headaches warrant a thorough evaluation to determine the underlying etiology. Primary headache disorders such as migraines should be considered, along with the potential for secondary causes requiring more extensive investigation. Appropriate management strategies, including both acute and preventive treatments, along with patient education, are crucial in alleviating her symptoms and improving her quality of life.

References

• Bendtsen, L., Ashina, M., & Jensen, R. (2016). Tension-type headache: a rational approach to diagnosis and management. The Practitioner, 260(1791), 11-17.
• Bigal, M. E., Rapoport, A. M., & Tepper, S. J. (2008). Clinical features of medication overuse headache. Current Pain and Headache Reports, 12(5), 424-429.
• Buchanan, J., Dunn, J., & Times, P. (2016). Diagnostic imaging in headache. Headache, 56(7), 1200-1207.
• Buse, D. C., McIlwain, E. L., & Finkel, A. G. (2019). Patient education in headache: A systematic review. Headache, 59(10), 1746-1757.
• Friedman, D. I. (2019). Management strategies and clinical impact of migraine. Neurology, 92(12), 546-556.
• Goadsby, P. J., Holland, P. R., & Magis, D. (2017). Cluster headache: A review. Nature Reviews Disease Primers, 3(1), 17018.
• Headache Classification Committee. (2018). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia, 38(1), 1-211.
• Lindsay, B., Johnson, R., & Moulton, R. (2019). The role of headache diaries in headache medicine. Headache, 59(3), 410-421.
• Schievink, W. I. (2015). Spontaneous subarachnoid hemorrhage. New England Journal of Medicine, 372(1), 50-59.
• Silberstein, S. D., et al. (2012). The role of prevention in the treatment of migraine. Neurology, 78(13), 1066-1076.