NEURO


HEADACHE

HPI:
23
YO
FEMALE
C/O
RIGHT
HEMISPHERE
HEADACHE
FOR
TWO
WEEKS,
THAT
RADIATES
TO
THE
LEFT

HEMISPHERE
AND
RIGHT
AURICLE.
THEY
OCCUR
2‐3
TIMES
A
DAY
AND
LAST
1‐2
HOURS,
THE
PAIN
IS

SHARP,
8/10
INTENSITY,
GETTING
WORSE,
HAPPENS
MOSTLY
IN
THE
MORNING.
PATIENT
REPORTS

AURA
PRIOR
TO
ONSET
OF
SYMPTOMS,
HALOS,
FLASHING
LIGHTS
AND
RIGHT
EYE
PAIN
WITH
THE

HEADACHES.
AFTER
THE
HEADACHE,
PATIENT
FEELS
FATIGUED.
AGGRAVATED
BY
NOISE
AND
BRIGHT

LIGHT,
RELIEVED
BY
SITTING
QUIET
IN
DARK
ROOM
AND
EXCEDRIN.
PATIENT
DENIES
BOWEL
OR

BLADDER
CHANGES,
MENTAL
STATUS
CHANGES.
NO
RELATIONSHIP
TO
MENSES,
FOOD,
OR
RECENT

TRAUMA.
PATIENT
DENIES
RECENT
INFECTION,
FEVER,
OR
CHEST
PAIN.

OBGYN:
MENARCHE
AGE
13,
LMP
NORMAL,
LPS
NORMAL,
NO
CHILDREN
NO
PREGNANCIES
DOES
NOT

USE
OCPS

ROS:
NEGATIVE
EXCEPT
AS
NOTED
ABOVE

ALLERGIES:
NKDA

MEDS:
EXCEDRIN
FOR
HEADACHE
RELIEF
3
TIMES
A
DAY

PMH:
NONE

PSH:
NONE

FH:
MOTHER
SUFFERS
FROM
MIGRAINES,
FATHER
ALIVE
AND
WELL

SH:
DENIES
TOBACCO,
ETOH,
DRUG
USE,
LIVES
WITH
PARENTS
WORKS
AS
A
NURSE



PHYSICAL
EXAM

GA:
PATIENT
IS
IN
ACUTE
DISTRESS

VS:
WNL

HEENT:

BILATERAL
TEMPORAL
TENDERNESS,
NORMCEPHALIC,
ATRAUMATIC,
PERRL,
NO
CYANOSIS,
NO

ICTERUS
NO
PALLOR

NECK:
SUPPLE,
NO
LAD,
THYROID
WNL,
NO
NUCHAL
RIGIDITY

MOUTH
AND
PHARYNX
CLEAR

HEART:
RRR
S1
S2
NORMAL

CHEST:
CTAB

NEURO:
CN
5
SENSATION
ON
RIGHT
OF
FACE
DECREASED,
CN
7
NOT
ABLE
TO
RAISE
EYEBROWS,
CN
11

NOT
ABLE
TO
SHRUG
SHOULDERS,
CN
3,
4,
6,
9,
10
INTACT,
MOTOR
STRENGTH:
5/5
THROUGHOUT,

REFLEXES:
DTR’S
2+
SYMMETRIC
AND
BILATERALLY,
SENSATION
INTACT
TO
DULL
AD
SHARP



DD:

MIGRAINE
HEADACHES

TENSION
HEADACHE

TEMPORAL
ARTHRITIS

MENINGITIS

CLUSTER
HEADACHE

SINUSITIS



WORK
UP:

CT
HEAD

MRI
BRAIN

CBC
WITH
DIFFERENTIAL

UA

LPS
CSF

CT
SINUSES