Aquifer Family Medicine #18
Which of the following are characteristics of migraine headaches? Select all that apply.
-Accompanied by nausea and vomiting.
-Moderate to severe pain.
You recognize that Sarah is asking for a specific diagnostic test and wants it to be done
urgently. Based on her history, you don't believe that Sarah will need an MRI urgently. Which
of the following are the next best steps? Select all that apply.
-Expand your history and perform your physical examination.
-Identify and address her primary concerns
Based on what you know about the patient so far, write a one-to-three sentence summary
statement to communicate your understanding of the patient to other providers.
Sarah is a 24-year-old female with a family history of migraines who presents complaining of
two types of chronic, progressively worsening headaches. The first type are severe,
throbbing, and unilateral with associated nausea, photophobia, and hyperacusis. They last
all day when present, occur one to two times weekly, are worse prior to menses, and do not
improve with ibuprofen, but does improve with hydrocodone. The second type are
mild-to-moderate and bilateral, last all day most days, and have associated neck discomfort.
On exam Sarah is afebrile with normal vital signs, has a mildly tender occiput, and has no
focal neurologic defects, signs of increased intracranial pressure, or meningeal irritation.
Dr. Lee asks you to consider your differential diagnosis for the cause of Sarah's two different
types of headaches, based on your findings from her history and physical exam. From the
following, select the two leading diagnoses.
-Migraine headache
-Tension-type headache
Which of the following are triggers that may increase the frequency and severity of Sarah's
headaches? Select all that apply.
A. Aspartame and phenylalanine
B. Caffeine
C. Emotional stress
D. Intense exercise
E. Sleep disturbance
Based on her history, which two of these would be the best options for Sarah? Select all that
apply.
-Ergot alkaloids
Which of the following are characteristics of migraine headaches? Select all that apply.
-Accompanied by nausea and vomiting.
-Moderate to severe pain.
You recognize that Sarah is asking for a specific diagnostic test and wants it to be done
urgently. Based on her history, you don't believe that Sarah will need an MRI urgently. Which
of the following are the next best steps? Select all that apply.
-Expand your history and perform your physical examination.
-Identify and address her primary concerns
Based on what you know about the patient so far, write a one-to-three sentence summary
statement to communicate your understanding of the patient to other providers.
Sarah is a 24-year-old female with a family history of migraines who presents complaining of
two types of chronic, progressively worsening headaches. The first type are severe,
throbbing, and unilateral with associated nausea, photophobia, and hyperacusis. They last
all day when present, occur one to two times weekly, are worse prior to menses, and do not
improve with ibuprofen, but does improve with hydrocodone. The second type are
mild-to-moderate and bilateral, last all day most days, and have associated neck discomfort.
On exam Sarah is afebrile with normal vital signs, has a mildly tender occiput, and has no
focal neurologic defects, signs of increased intracranial pressure, or meningeal irritation.
Dr. Lee asks you to consider your differential diagnosis for the cause of Sarah's two different
types of headaches, based on your findings from her history and physical exam. From the
following, select the two leading diagnoses.
-Migraine headache
-Tension-type headache
Which of the following are triggers that may increase the frequency and severity of Sarah's
headaches? Select all that apply.
A. Aspartame and phenylalanine
B. Caffeine
C. Emotional stress
D. Intense exercise
E. Sleep disturbance
Based on her history, which two of these would be the best options for Sarah? Select all that
apply.
-Ergot alkaloids
