what can be 4 differential Diagnosis? 24 year old HPI:…
what can be 4 differential Diagnosis?
24 year old
HPI: Worsening of migraine headaches on combined oral contraceptives (Cyclessa)
O: Gradually increasing in frequency and intensity since starting Cyclessa 4 months ago.
L: Typically above left eyebrow, left temple, left ear and mastoid area
D: Headaches last from 4-12 hours and occur 1-2 times per week now. This is a change from her baseline of 4-5 times per year, usually at the time of her menses.
C: Pain is described as throbbing, pulsating
A: Associated symptoms: Nausea, occasionally vomiting; over last 3 headache episodes has had visual changes just prior to the pain – in left eye field only and appears as zig zag lines shimmering, pulsating in a crescent shape in peripheral aspect of vision. Visual changes resolve as pain starts.
Aggravating: Unable to work on the computer or do housework due to pain worsening; lights and sounds makes it worse
Alleviating: Sleep; usually “Advil Migraine” relieves the pain but has not been effective last few episodes
R: Pain does not radiate.
T: No relation to time of day, occurs once to twice weekly. No longer correlated with menses.
S: Moderate to severe, ranges from 6-10 /10. Interferes with activity.
Family hx: mother, sister – migraines; maternal grandmother – CVA at age 54; mother – phlebitis x 1 after 3rd pregnancy
PMH: G2P2 (SVD x 2; healthy 3-year-old male, healthy 1-year-old female); pre-eclampsia in both pregnancies without complications; migraine headaches (diagnosed age 16); no surgeries
Medications: Cyclessa 1 tab daily – last dose this morning, Vitamin D3 2000IU daily – last dose this morning, Probiotic 2 daily, last dose this morning, Advil Migraine 200mg tabs 2 tabs every 4 hours PRN – last dose 2 days ago at 4pm.
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