Case and Discussion: Headache

A 35-year-old woman comes to your office to discuss her “bad headaches,” which started after having her first child 2 years ago. The headaches sometimes awaken her from sleep and at times can be disabling and occasionally require her to take Tylenol and rest in a dark room. Sometimes she vomits during an attack. Over the past 6 months, her headaches have become more severe and frequent, prompting her visit today. • What additional questions would you ask to learn more about her headaches? • How do you classify headaches? • How can you determine if this is an old headache or a new headache/s? Is this a chronic or episodic condition? • Can you make a definite diagnosis through an open-ended history followed by focused questions? • How can you use the patient history to distinguish between benign headaches and serious ones that require urgent attention? • What diagnostic tests do you want to include to help you with your diagnosis? Create a differential diagnosis flow sheet for this patient