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What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?

June 19, 2021
Christopher R. Teeple

Describe the pathology of a headache.
Headaches can occur for a variety of reasons. They are frequently caused by irritation of the meninges, blood vessels, or other sites containing pain receptors. Headaches can be caused by blood vessel spasms, strokes (ischemic or hemorrhagic), trauma, infections (including meningitis), sinus infections, stress, caffeine, or vertebral, muscular, and nerve origins. Wei et al. (2014) discovered that applying lipopolysaccharide (LPS) significantly increased the action potential of neurons, implying that fibroblasts may also play a role in headache genesis.
Based on the different etiologies for headaches, which of those fit this patient’s situation?
Migraine without aura — Symptoms include one-sided discomfort, but no nausea, vomiting, or chilly hands. Allergy headaches are similar to nasal congestion and watery eyes, although they are more widespread. Cervicogenic headaches are characterized by discomfort on one side of the head and around the eyes, but no runny nose or weeping. Cluster headache — pain around the eye, nasal congestion, and tearing of the eyes, although no burning has been reported. The headaches last for days or weeks and can last up to a year, yet they only emerge at night, which does not match the client’s description. Based on the facts provided, this appears to be the best match for the client’s history.
What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
Is there a history of headaches in the client’s family, and if yes, when did they start? Is there a history of diagnosis? each headache’s onset, length, intensity, location, pain description, triggers, auras, and relieving elements, allergies to certain seasons in the past, caffeine, alcohol, and smoking history, is the client getting a good night’s sleep? do you use any illegal substances?, stress Levels, is there any history of trauma prior to the onset of the headaches?, the impact on Activities of Daily Living,  and Medications for headaches and other ailments currently in use
Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/(Links to an external site.)(Links to an external site.) (Links to an external site.) as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.
Some of the symptoms match those of migraines without aura, but we don’t have enough information to be sure. Migraine without an aura is one-sided and is accompanied by nausea, vomiting, cold hands, and sound and light sensitivity. The client reported his or her pain as “burning,” with no mention of nausea, vomiting, or sensitivity to stimuli. In addition, the client stated that he was tearing up and had a runny nose, which does not appear to be consistent with the diagnosis.

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