Week 6-Signature Assignment-Headache
Your patient presents at your clinic today with a chief complaint of headache.
You have the following information:
34 year old Caucasian female, BMI 25, BP: 128/82, Pulse 84, O2 99% RA, Pain 3/10
Patient is comfortable in the office and sits in a chair. No acute distress
PMH: endometriosis, seasonal allergies
Medications: Naproxen and Excedrin prn
SH: denies smoking, occasional alcohol use, denies current drug use (hx unknown)
Upon interviewing the patient reports a many year history dating back to her teen years of headaches that
were mostly infrequent. The past 6 months she has noticed the frequency increase and somewhat worse
intensity when they occur. She does not describe this as the worst headache of her life. She reports 5-10
headache days per month. The pain is usually unilateral and throbbing/pulsing and can last several hours.
Pain can be an 8/10 when they occur. She reports feeling of nausea and sensitivity to light and sound when
they occur causing her to hide in her darkened bedroom until it subsides. She reports taking naproxen or
Excedrin which helps to ease the pain. She does not notice any aura prior to an episode.
Physical exam: Neuro, HEENT, and Cardio/Pulmonary exams negative
1. Describe the pathophysiology of the trigeminovascular pathway leading to headaches.
1b. Briefly describe the role of Calcitonin Gene-Related Peptide (CGRP) as it pertains to headaches and
the headache pathway.
1. List 4 possible “red flags” to evaluate for when interviewing headache patients. Include brief rationale of
significance for each
2. What is your diagnosis for this patient? Include rationale to support.
3. As you formulate your plan of care for this patient, describe one topic of patient education you would like
to discuss with this patient.
4b. How would you educate the patient regarding rebound headaches and medication overuse?