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Get Writing Help Now!A 32 year-old Asian American female presents at the clinic for a history of recurrent headaches that occur on a monthly basis and last between 12-18 hours at a time. The headaches are sometimes associated with nausea, vomiting, and photophobia, and she typically takes acetaminophen or ibuprofen for these headaches with mixed results. She also uses Ortho Tricyclin as a primary form of birth control, and her physical exam was normal.
Differential Diagnosis
Based upon the specific symptoms and the patient’s chief complaint, the primary differential diagnoses for this patient include migraine headaches, tension headaches, and cluster headaches, all of which possess some of the same overlapping symptoms (UpToDate, 2014). Common migraine symptoms may include visual phenomena during aura, vision loss, speech problems, nausea, and vomiting, all of which may occur at differing levels of severity (Mayo Clinic, 2014).
Tension headaches are typically chronic in nature and include neck and muscle tension, excess caffeine use or withdrawal, fatigue, and eye strain, and the primary symptoms include dull pain that occurs in the temples or in the shoulders or is isolated to other areas, and difficulties in sleeping patterns (National Library of Medicine, 2014). These headaches do not typically cause nausea and vomiting in most cases (National Library of Medicine, 2014).
Cluster headaches are characterized by symptoms such as sweating, watery eyes, low tolerance to sound and light, and swollen eyelids (University of Maryland Medical Center, 2014). These headaches are rare and impact one percent or less of the population (University of Maryland Medical Center, 2014).
Based upon the information provided by the patient and her current symptoms, it is highly likely that she is suffering from a series of migraine headaches, which have been primarily characterized by nausea, vomiting, and photophobia, all which last for 12-18 hours and which are debilitating for the patient on many levels.
Treatment and Management
The patient’s use of Ortho Tricyclin is not the most feasible option for birth control, as it is a combination of estrogen and progestin and may contribute to an increased number of migraines; therefore, a progestin-only option is highly desirable and should be taken daily (The Migraine Trust, 2012). A successful approach to managing migraine headaches also requires medication to treat the migraines directly, and the most feasible approach is a drug from the Triptan family known as zolmitriptan (Zomig) (Impax Pharmaceuticals, 2014). The recommended dosage is 1.25 mg daily and if there is no relief, and increase to 2.5 mg daily is desirable when migraine symptoms persist (Impax Pharmaceuticals, 2014). In the event that this medication is unsuccessful, the patient should make an appointment to visit with her primary physician in order to determine another possible medication that might be a more effective treatment method if the headaches persist.
Education
It is strongly recommended to take all required medications as necessary in order to prevent migraines as much as possible. This also requires an adoption of specific lifestyle interventions and changes that will support the avoidance of migraine triggers as much as possible. These factors may include the removal of food and beverage triggers from the diet that may exacerbate migraines, such as chocolate and caffeine; increased exercise on an average of 30 minutes per day several days per week; and achieving consistent sleeping patterns, with an effort to sleep 7-8 hours or more per night. These alternatives are likely to motivate individuals to achieve greater consistency in their habits in order to prevent migraines as much as possible.
References
Mayo Clinic (2014). Migraine: symptoms. Retrieved from http://www.mayoclinic.org/diseases-conditions/migraine-headache/basics/symptoms/con-20026358
The Migraine Trust (2012). Migraine and the contraceptive pill. Retrieved from http://www.migrainetrust.org/factsheet-migraine-and-the-contraceptive-pill-10894
National Library of Medicine (2014). Tension headache. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000797.htm
University of Maryland Medical Center (2014). Headaches – cluster. Retrieved from http://umm.edu/health/medical/reports/articles/headaches-cluster
UpToDate (2014). Patient information: headache causes and diagnosis in adults (beyond the basics). Retrieved from http://www.uptodate.com/contents/headache-causes-and-diagnosis-in-adults-beyond-the-basics
Zomig.com (2014).Other forms of Zomig. Retrieved from http://www.zomig.com/Other-forms-of-ZOMIG
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