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“I have used up most of my sick leave, and I am not sure my boss will give me extra days in the future. We have to take care of these headaches, or I may lose my job.”
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History of Present Illness
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KS is a 31-year-old female referred to an outpatient neurology clinic for assessment and treatment of her headaches. She reports that the headaches have increased in frequency and severity to the point that they interfere with her daily life and may lead to losing her job.
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What signs and symptoms allow the practitioner to differentiate this as a migraine headache with aura from others such as migraine headache with aura, tension-type headache, or cluster headache?
Hint: See Clinical Presentation and Diagnosis of Headaches in PPP
What lifestyle issues, medical comorbidities, or medication therapies may be contributing to the development and/or perpetuation of headache symptoms, as well as potentially complicating therapy in this patient?
Hint: See Treatment of Headache Disorders, Special Populations and Table 36-2 in PPP
What nonpharmacological measures or CAM therapies might you recommend to reduce the number of HAs, as well as provide pain relief during an acute HA?
Hint: See Treatment of Headache Disorders and Table 36-2 in PPP
What would you recommend for acute pharmacologic therapy, as well as prophylactic treatment, if applicable?
Hint: See Treatment of Headache Disorders, Special Populations and Table 36-3, 36-4 in PPP
How will the practitioner assess the outcome of the interventions, assess the need for alterations and/or additions in the chosen treatment regimen?
Hint: See Special Populations in PPP
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How does the treatment of other different types of headaches differ from that of migraines?
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Headache is the most common condition seen by neurologists, with tension-type HAs (TTH) being the most common primary headache (HA) disorder. Despite its higher prevalence, the societal impact of TTH is much less than that of migraines. Unlike in cluster HAs, females predominate in chronic TTH and migraine cohorts compared to males. The peak incidence of all three HA types occurs in the middle-aged, with some data suggesting that attacks diminish with age. Complementary and alternative medicine (CAM) approaches to HA treatment and prevention are more commonly employed in non-Western societies, with acupuncture demonstrating benefit in limiting headache frequency in clinical trials. Multiple herbal remedies are purported to have analgesic, antispasmodic, and ...