Hot clinic

Impression: Possible diagnosis of migraine with aura. Past Medical History: 1. Hypertension 2. Hyperlipidemia Current Medications: 1. Amlodipine 5mg daily 2. Atorvastatin 20mg nightly Management Plan: 1. Patient to keep a headache diary. 2. Review in 3 months. I reviewed this 38-year-old right-handed female who attended the neurology hot clinic. She is a teacher who was referred with recurrent headaches with visual aura. She denies any recent fever, neck stiffness, or altered mental status. Her husband reports that the headaches started approximately 6 months ago, occurring 2-3 times per month, lasting for 4-6 hours. The headaches are preceded by visual aura, including flashing lights and zig-zag lines. The headaches are throbbing in nature, located on the left side of her head, and are associated with nausea and photophobia. The headaches are relieved by rest and over-the-counter pain medication. Her husband reports that she has not received any previous treatment for her headaches. She has a history of hypertension and hyperlipidemia. Her mother has a history of migraines. She lives with her husband and two children. She drinks alcohol socially, smokes occasionally, and does not use any illicit drugs. She is fit to drive. The neurological examination: Cranial nerves II-XII were intact. Motor strength was 5/5 in all extremities. Sensory examination was normal. Reflexes were 2+ and symmetrical. Cerebellar function was intact. Gait was normal. Summary: Based on the history, examination findings, and investigations, the patient's symptoms are highly suggestive of migraine with aura. The agreed management plan is to start a headache diary and review the patient in 3 months. I would be grateful if you could continue to monitor the patient's blood pressure and lipid levels.