Migraine Headache

HISTORY:

‍Headache suggestive of migraineHeadache for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Location: ‍generalized, on the ‍rightleft

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍throbbingpulsating

Pattern: ‍constantintermittent, worse during the ‍day

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍aura

‍visual disturbances

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍photophobia

‍phonophobia

‍numbess or tingling

‍weakness

‍speech difficulty

‍dizziness

‍loss of conscisousness

‍irritability

‍fatigue



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumaticnormal scalprashlesion

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Cervical spine: ‍no tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

‍Migraine headache ‍likelysuspectedpossible

DDx: ‍



PLAN:

- CT scan of the head

- MRI of the head

- Blood work: ‍CBC, ‍TSH, ‍CRP, ‍ESR

- ‍Acetaminophen

- ‍NSAIDs

- ‍Triptans

- ‍Muscle relaxants

- ‍Prophylaxis medications

- Avoid medication overuse (more than 10 days per month) to prevent rebound headaches

- Avoidance of triggers (e.g. caffeine, alcohol, stress)

- Regular exercise

- Stress management techniques

- Good sleep hygiene

- Referral to neurologist

- Follow-up in ‍ ‍weeksmonths

- Return if headaches worsen, if new symptoms develop such as vision changes or weakness, or if symptoms do not improve with treatment