Case-12: Headache
Table of Contents
- Brief Scenario
- Information for Student about the Case
- Task
- Information for the Simulated Patient
- Doctor’s Instructions
- Professional Behavior
- History Taking Skills
- Clinical Examination
- Management
- Summary
- Notes
Case-12: Headache
Patient Brief Record / Brief Scenario
Information for Student about the Case
- Patient Name: Hanan
- Age: 30 years
- Occupation: Employee in a bank
- Not known to have any chronic illness
- Today:
- BP: 120/78 mm Hg
- Temperature: 37.3°C
Hanan is a 30-year-old who presented today with the complaint of a headache.
Task
- Take a focused history from this patient to arrive at the most likely diagnosis.
- Perform the relevant clinical examination.
- Inform the patient about the diagnosis.
- Manage the patient appropriately.
- Explain to the patient the management plan.
Patient Brief Record / Brief Scenario
Information for the Simulated Patient
- Patient Name: Hanan
- Age: 30 years
- Occupation: Employee in a bank
- Marital Status: Married, with 2 children (1 and 3 years old)
Opening Scenario: “Doctor, I have a headache since a few weeks…”
Tell your doctor about the following information only if specifically asked about:
- You are suffering from the headache for the past 6-8 weeks.
- The headache comes at least one episode every week.
- The headache is severe and throbbing in nature (pulsatile: like you feel that the headache is pulsating).
- Usually felt over the left side of the head.
- It lasts a few hours or even the whole day.
- You feel nauseating (about to vomit), and sometimes you vomit before the headache. The vomiting is normal, not very forceful (projectile).
- When you have a headache, you enter a room and make it dark, which helps in reducing the headache.
- You take Brufen tablets, which helps but not much.
- Your mother also suffers from such a type of headache but not as severe as yours.
- No other problems. Apart from the headache, you are healthy.
- Home and work situation is OK, no extra stress.
- Your idea: it could be a migraine as your mum is suffering from it.
- Your concern: Why it is so severe, you are worried about a brain tumor.
- You are now taking COC pills.
- Your expectations are:
- That your doctor will give you a stronger analgesic than Brufen.
- Do an MRI to find the possibility of a brain tumor.
Ask your doctor about:
- Insist on the idea of a brain tumor, possibly.
- Therefore, you want an MRI to exclude the tumor. If he convinces you about it in an appropriate way, agree with him that it is not necessary.
The doctor will examine your eye movements. You will act naturally.
1- Professional Behavior
- Introduces himself and gets permission to take history and do the examination.
- Starts with an open-ended question.
- Develops rapport with the patient.
2- History Taking Skills
- Explore the problem by exploring different symptoms to differentiate between primary and secondary headaches.
- Ask about some sinister symptoms like early morning projectile vomiting, diplopia, or any other neurological symptoms.
- Family history of headache or any other problem.
- Smoking.
- Medications.
- Social history (home or work stress).
- Ongoing problem/past history.
- Summarizes to the patient about the history taken from him.
- Explores well the patient’s idea, concern, and expectation.
3- Clinical Examination
- General Examination:
- Vital signs.
- Examination of the third, fourth, and sixth cranial nerves.
- Any other related examination could be included for students’ benefits.
4- Management
- Explore the patient’s understanding about migraine headache and its management.
- Explain the pathophysiology of migraine headache and the possibility of a brain tumor is unlikely.
- No need for an MRI and its pros and cons.
- Discussion about prophylactic treatment.
- Changing treatment to the Tryptans group.
- Arrive at a shared understanding.
- Invite questions from the patient.
5- Summary
- Summarize at the end of the consultation.
- Follow-up arranged.