Question

Twelve-year-old F is brought to the clinic by her mother with a report of blurred vision, vomiting, and

severe headaches. Upon further questioning, the nurse obtains the following information:

- Onset of menses 3 months ago with last period ending 3 days ago.

- Headaches began about 6 months ago.

- Headaches that tend to be unilateral and are described as throbbing and lasting as long as a day.

- Accompanying symptoms include severe nausea, blurred vision, and sensitivity to light.

- Her mother reports having similar headaches when she was “that age”.

1. What type of headache does the nurse think S is experiencing? Give a rationale for your answer.

  

2. What are the pathophysiology mechanisms associated with this type of headache?

3. What are some possible triggers for this type of headache?

4. Briefly describe the symptoms associated with other types of headache.

Answer 1

1.I think it is migraine headache. It is a recurring headache characterized by unilateral or bilateral throbbing pain ,a triggering event or factor, strong family history snd manifestations associated with neurologic and autonomomic nervous system dysfunction. By puberty, migraine headaches are more common in girls and by the late teens.

2 There are different theories attempt to explain the etiology of migraine .The vascular theory suggests that vasoconstriction followed by vadodilation with resulting changed in blood flow causes the throbbing pain. A second theory proposes that the pain is a result of muscular tendion and thus is related to tention -type headache. The third theory relates to biochemical changes, proposing that changes in the serotonin pathway result in the headache pain During a migraine headache, the serotonin stored in platelets is released into the plasma and become inactive, thus altering the serotonin pathway.

3Migraine headache, in many cases, have no known precipitating events. However, for other patients, the headache maybe precipitated or triggered by foods, hormonal fluctuation, head trauma, physical exertion, fatigue, stress and pharmacologic events. Food triggers include chocolate, cheese, oranges, tomatoes, onions monosodium glutamate, aspartame, red wine and alcohol.

4In tension headache, there is bilateral, bandlike pressure at base of skull, in face or in both. The symptoms are palpable neck and shoulder muscles, stiff neck and tenderness.

Cluster headache it is unilateral, radiating up or down from one eye. Vasomotor symptoms such as facial flushing or pallor, unilateral lacrimation, ptosis and rhinitis.