Week 6 CEA Pre-Diagnostic Exam Case Study Discussion - Part 1
Initial Post
Hello Dr. Davis and class,
Patient Information
Chief Complaint: Frontal headache
HPI: M. S. is a 31-year-old female present with complaints of a headache located across
her forehead and both sides of her forehead. She further reports her headache as
moderate, dull, pressure pain ongoing since x 6 days ago. Additionally, she has been
undergoing severe emotional stress regarding relationship problems with her boyfriend as
well as work-related stress as a restaurant chain regional manager. Combined stresses
have caused her to suffer insomnia for the last month in which she obtains 3-4 hours of
sleep nightly. She reports a lack of interest in eating as she, “Doesn’t have time and is
always on the go” and admits to poor daily water intake. Furthermore, she denies cold or
flu symptoms, recent illness, fever, chills, dizziness, auras, nausea/vomiting, or night
sweats.
Demographic: Caucasian
Current Medications: Daily Multivitamin gummies PO QD and etonogestrel
(Nexplanon) 68 mg subdermal contraceptive insertion left bicep.
PMHx: Generalized Anxiety Disorder, GERD
PSHx: Appendectomy age 8-years-old
Familial Hx: Mother and sister are prone to tension migraines.
Social Hx: Non-smoker, denies recreational/IV drug use, drinks 2-3 cocktails 3-4x
weekly with coworkers to help decompress after shifts
Allergies: NKDA
Risk Factors Associated with Chief Complaint: Stress, insomnia, alcohol misuse, dehydration,
poor daily nutritional intake, SD contraceptive, hx of GAD, genetic predisposition to tension
headaches.
3 Common Differential Diagnoses Associated with Chief
Complaint (Prevalence/Pathophysiology/Clinical Presentation/Rationale):
1. Tension-type Headache (TTH):
o Prevalence- As per Onan et al. (2023), the prevalence of tension-type headaches
among U.S. adults is reported to be as high as 43% resulting from several genetic
and environmental factors.
, o Pathophysiology- According to Onan et al. (2023), the exact mechanism of the
pathology is not fully understood. However, TTHs are believed to be caused by
peripheral myofascial nociception in episodic cases and by central sensitization in
chronic cases. The transition from episodic to chronic TTH involves both
peripheral and central mechanisms (Onan et al., 2023). In addition, clinical
manifestations of TTH are correlated in patients with sleep disturbances,
psychiatric comorbidities, and mental distress disorders further attributing to
overall autonomic dysfunction and thus resulting in the onset of TTH (Onan et al.,
2023).
o Clinical Presentation- Mild to moderate head wrapping pain without
visual/auditory disturbances typically lasting from 1 hour to 1 week and resolves
with reduction/mitigation of triggering factors.
o Rationale- Diagnosis of TTH is determined by the presence of cardinal symptoms
including a band-like pressure, dull pain located bilaterally on the head without
nausea, vomiting, and visual or auditory disturbances (Onan et al., 2023).
Notably, the patient’s given risk factors of female sex, familial disposition to TTH
per her mother and sister histories, poor nutritional status, lack of optimal sleep,
and psychological factors such as poor stress management as evidenced by her
coping mechanism with alcohol misuse are all contributable and convincing
reasons for her presenting symptoms. Therefore, it is appropriate to suggest she is
suffering from an acute onset of TTH in contrast to the other corresponding
differentials.
2. Migraine w/o aura:
o Prevalence- According to Onan et al. (2023), the prevalence of migraines without
auras are three times higher among women in comparison to men at
approximately 33% of U.S. women in America. Furthermore, migraine prevalence
peaks in late teens-early 20s with an additional peak during a woman’s highest
reproductive years, although, symptoms are exacerbated during menopause (Onan
et al., 2023).
o Patho- As per Onan et al. (2023), the direct pathophysiological causation of
migraines is not yet fundamentally understood, although, there are several driven
theories involving the trigeminovascular system. However, it is well understood
that certain factors significantly play a role in migraine impact: 80% emotional
stress, 65% hormones, 57% lack of proper diet/eating, 53% weather disturbances,
and 50% poor sleep (Onan et al., 2023).
o Clinical Presentation- According to the International Classification of Headache
Disorders (ICHD), migraines without auras are characterized by sudden onset of
moderate to severe throbbing pain located in either the frontal, temporal, or retro-
orbital areas, although typically unilateral, and lasting 4-72 hours (Onan et al.,
Initial Post
Hello Dr. Davis and class,
Patient Information
Chief Complaint: Frontal headache
HPI: M. S. is a 31-year-old female present with complaints of a headache located across
her forehead and both sides of her forehead. She further reports her headache as
moderate, dull, pressure pain ongoing since x 6 days ago. Additionally, she has been
undergoing severe emotional stress regarding relationship problems with her boyfriend as
well as work-related stress as a restaurant chain regional manager. Combined stresses
have caused her to suffer insomnia for the last month in which she obtains 3-4 hours of
sleep nightly. She reports a lack of interest in eating as she, “Doesn’t have time and is
always on the go” and admits to poor daily water intake. Furthermore, she denies cold or
flu symptoms, recent illness, fever, chills, dizziness, auras, nausea/vomiting, or night
sweats.
Demographic: Caucasian
Current Medications: Daily Multivitamin gummies PO QD and etonogestrel
(Nexplanon) 68 mg subdermal contraceptive insertion left bicep.
PMHx: Generalized Anxiety Disorder, GERD
PSHx: Appendectomy age 8-years-old
Familial Hx: Mother and sister are prone to tension migraines.
Social Hx: Non-smoker, denies recreational/IV drug use, drinks 2-3 cocktails 3-4x
weekly with coworkers to help decompress after shifts
Allergies: NKDA
Risk Factors Associated with Chief Complaint: Stress, insomnia, alcohol misuse, dehydration,
poor daily nutritional intake, SD contraceptive, hx of GAD, genetic predisposition to tension
headaches.
3 Common Differential Diagnoses Associated with Chief
Complaint (Prevalence/Pathophysiology/Clinical Presentation/Rationale):
1. Tension-type Headache (TTH):
o Prevalence- As per Onan et al. (2023), the prevalence of tension-type headaches
among U.S. adults is reported to be as high as 43% resulting from several genetic
and environmental factors.
, o Pathophysiology- According to Onan et al. (2023), the exact mechanism of the
pathology is not fully understood. However, TTHs are believed to be caused by
peripheral myofascial nociception in episodic cases and by central sensitization in
chronic cases. The transition from episodic to chronic TTH involves both
peripheral and central mechanisms (Onan et al., 2023). In addition, clinical
manifestations of TTH are correlated in patients with sleep disturbances,
psychiatric comorbidities, and mental distress disorders further attributing to
overall autonomic dysfunction and thus resulting in the onset of TTH (Onan et al.,
2023).
o Clinical Presentation- Mild to moderate head wrapping pain without
visual/auditory disturbances typically lasting from 1 hour to 1 week and resolves
with reduction/mitigation of triggering factors.
o Rationale- Diagnosis of TTH is determined by the presence of cardinal symptoms
including a band-like pressure, dull pain located bilaterally on the head without
nausea, vomiting, and visual or auditory disturbances (Onan et al., 2023).
Notably, the patient’s given risk factors of female sex, familial disposition to TTH
per her mother and sister histories, poor nutritional status, lack of optimal sleep,
and psychological factors such as poor stress management as evidenced by her
coping mechanism with alcohol misuse are all contributable and convincing
reasons for her presenting symptoms. Therefore, it is appropriate to suggest she is
suffering from an acute onset of TTH in contrast to the other corresponding
differentials.
2. Migraine w/o aura:
o Prevalence- According to Onan et al. (2023), the prevalence of migraines without
auras are three times higher among women in comparison to men at
approximately 33% of U.S. women in America. Furthermore, migraine prevalence
peaks in late teens-early 20s with an additional peak during a woman’s highest
reproductive years, although, symptoms are exacerbated during menopause (Onan
et al., 2023).
o Patho- As per Onan et al. (2023), the direct pathophysiological causation of
migraines is not yet fundamentally understood, although, there are several driven
theories involving the trigeminovascular system. However, it is well understood
that certain factors significantly play a role in migraine impact: 80% emotional
stress, 65% hormones, 57% lack of proper diet/eating, 53% weather disturbances,
and 50% poor sleep (Onan et al., 2023).
o Clinical Presentation- According to the International Classification of Headache
Disorders (ICHD), migraines without auras are characterized by sudden onset of
moderate to severe throbbing pain located in either the frontal, temporal, or retro-
orbital areas, although typically unilateral, and lasting 4-72 hours (Onan et al.,
