Pathophysiology
Clinical Case Study Analysis: Headaches
Pathophysiology
Introduction.
A 17 year old female complaining of chronic headaches.
She says she has been having headaches for the past 6 months.
Her headaches begin with wavy visual distortion for roughly 20 minutes, followed by nausea and head throbbing for 3+ hours. She also says It feels like a constant head banging.
It typically begins to be resolved after getting some sleep, or taking ibuprofen of 600 mg. Her headache begins to get worse as her menstruation begins to get closer.
Background details.
The patient says she’s come to realize with the headache she begins to develop mood changes, nausea, difficulty concentrating and irritability.
Triggers include caffeine, lack of sleep, and not eating enough.
The pain feels as though her head is pulsating. The pain intensity varies from moderate to severe.
She has sensitivity to light and sounds. The headaches can last anywhere from 1 to 72 hours.
Out of the 6 months that this has been happening, for each month it happens 15 days out of the 30. She has been missing a lot of school due to these headaches because she can not concentrate.
Clinical assessment.
What should be done now knowing the patients history is the general physical assessment. This should include vital signs being taken as well as temperature.
A general examination is done as well, with a focus on the head and neck, and a full neurologic examination is done.
The eyes are inspected. Pupillary size and light responses, extraocular movements and visual fields are assessed.
She has been diagnosed with an acute migraine.
Recommendations.
For patients with acute migraines it is best to try and figure out what may trigger them. Write down when headaches begin after eating a certain food or doing a certain activity.
Rest in a quiet room.
Use a hot compress to your head or neck.
Patients are encouraged to eliminate vasoactive substances from their diets, including caffeine, cheese, chocolate, and foods containing nitrates.
Take over the counter medications such as ibuprofen, acetaminophen, and aspirin.
If the headaches seem to worsen it is best to be introduced to complementary therapies.
Application for future practice.
Assess for active trigger points in the muscles of the neck, and around the shoulders. This search may lead the skilled examiner to extend the examination into the upper extremities and torso.
Physical assessment should include the ears, nose and throat, sinuses, neck, cranial nerves, and retinal examination.
General cognitive, neurologic, and motor function should also be examined.
Patient should seek further assistance if symptoms worsen.
References.
Evaluation of acute headaches in adults; Am Fam Physician (February 2001) Retrieved on January 10, 2021 from https://www.aafp.org/afp/2001/0215/p685.html#:~:text=The%20examination%20should%20target%20areas,the%20findings%20must%20be%20documented.
NICE; Headaches in over 12s: diagnosis and management (September 19,2012) Retrieved on January 10, 2021 from https://www.nice.org.uk/guidance/cg150/chapter/Recommendations#assessment
NCBI; Assessment of acute headache (October 2018) retrieved on January 10, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334100/
Jacquelyn L. Banasik_Lee-Ellen C. Copstead – Pathophysiology (2019, Elsevier) – libgen.lc.pdf
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