Case #1: For over 15 years, James, aged 64, has had severe, intermittent headaches. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last about an hour. James can be headache free for months at a time, but the attacks always return.
1. Describe the pathology of a headache.
2. Based on the different etiologies for headaches which of those fit this patients situation?
3. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?
4. Based on the history provided and using the following diagnostic tool https://headaches.org/resources/the-complete-headache-chart/ (Links to an external site.) as a quick reference of the guideline, you diagnose migraine without aura. List the evidence that supports your diagnosis.
Case #2: Mr. Smith is a new patient with a history of recent stroke approximately 3 months ago. He was hospitalized in another state, but you don’t have his records now. The patient’s wife is extremely anxious and worried about him because he hasn’t been “acting right”. She wants him checked out. She does not think he had hypertension but adds “he does not like to go to doctors.”
1. Regarding the patient’s available history, create a detailed plan of care for this patient.
2. In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024 (Links to an external site.). Based on these current guidelines what goals would you recommend for this patient to insure prevention of another brain ischemic event?
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