Week 2
12:30-1:30
HEADACHE
Case 1: A
24-year-old female law student presented with a
six-month history of intermittent headaches. The
headaches were usually located in the left, but
sometimes in the right, temporal or vertex areas. Pain
was variously described as aching or throbbing.
Sometimes, there was queasiness of the stomach, but no
vomiting. The headaches could last hours or up to 1-2
days. Aspirin had been of no benefit. A sister had
similar headaches. Among her many medical concerns was a
fear of a brain tumor.
1. What are the major categories of headaches?
2. How is a
migraine headache distinguished clinically
from a tension type headache?
3. What is the likely diagnosis in this 24-year-old
woman?
4. What is the difference between common, classic and
complicated migraine?
5. What medications might be useful in treatment of this
case?
6. What are the "danger signs and symptoms" of a
serious
headache?
7. What ways do
brain tumors typically present?
Case 2: A
42-year-old housewife, who had been in good health,
complained of the worst headache of her life. Six hours
before arrival in the emergency room, while stepping
down from a bus carrying groceries, she developed the
sudden onset of severe pain behind the eyes, accompanied
by light-headedness and nausea. Visual changes and
sensorimotor focal symptoms were absent, but the patient
admitted feeling unwell since the onset of pain. All
symptoms improved while waiting in the ER triage line.
1. What headaches may present suddenly?
2. What physical signs should be sought after diligently
in this case?
3. What would be the management in the emergency room of
this patient?
Case 3: A
76-year-old, right-handed man had a nagging headache
worst on the left, which had continued to slowly worsen
over the past three weeks. His jaw on the same side
ached when he chewed. He also complained of muscle aches
in his shoulders and a general "tired" feeling.
1. What is the differential diagnosis in this
76-year-old man?
2. What is the proper laboratory evaluation in this
patient?
3. What is the appropriate therapy and evaluation for
this patient?
4. Review the complications of this disorder if not
recognized and treated.
Case 4: A
62-year-old, right-handed man suffered from intense
shooting pains in his left cheek, each lasting for a
second. He avoided touching certain parts of his face
because of fear of setting off an attack, and had taken
to chewing food on the right side of his mouth. Between
attacks, he felt normal. His neurologic exam was normal.
1. What is the likely diagnosis in this 62-year-old
man?
2. What investigations are indicated?
3. How should this man be managed? |
