GP Follow-up Note

Date: 1 November 2024 Reason for Follow-up: Patient reports continued improvement in headache frequency and severity since starting new prophylactic medication. Reports only 2 mild headaches in the past month, lasting less than an hour each, compared to daily severe headaches previously. No associated aura, photophobia, or phonophobia. Denies any new concerns. Repeat Clinical Review: Blood pressure 128/82 mmHg (previously 135/88 mmHg). Heart rate 72 bpm, regular. Respiratory rate 16 breaths/min. Temperature 36.8°C. Neurological examination remains unremarkable, no focal deficits noted. Patient appears well and alert. No tenderness on palpation of paranasal sinuses or neck muscles. Repeat Biochemistry Review: Full Blood Count: Within normal limits. Liver Function Tests: ALT 25 U/L (ref range <40), AST 20 U/L (ref range <35), ALP 70 U/L (ref range 30-130). Renal Function Tests: Urea 4.5 mmol/L (ref range 2.5-7.8), Creatinine 78 µmol/L (ref range 60-110). All values are stable and within normal ranges, showing no adverse effects from new medication. Previous LFTs were also normal. Repeat Imaging: Repeat MRI brain not indicated at this stage given positive clinical response and stability of symptoms. Initial MRI brain from 3 months ago showed no abnormalities. Plan: Continue current prophylactic medication (Propranolol 40mg BID). Advised to continue headache diary. Reassessed need for further imaging, decided against at present. Will review in 3 months time or sooner if symptoms worsen or new concerns arise. Patient encouraged to maintain adequate hydration and sleep. Provided information leaflet on headache management.