NeuroMed 1st Consultation

Neurologist - NeuroMed 1st Consultation A 45-year-old female, referred by Dr. Sarah Chen, presented with a chief complaint of chronic, progressive headaches. Migraine with aura, affecting a 45-year-old female. - Duration of main symptom: The headaches have been ongoing for approximately 8 months. - Key investigation and result: Cranial MRI, performed on 1 November 2024, revealed no structural abnormalities or space-occupying lesions. - Working diagnosis or differential diagnosis: Chronic Migraine vs. Hemicrania Continua. History of Presenting Illness * Onset 8 months ago, gradually worsening over time. * Headaches are primarily unilateral, throbbing in nature, and localised to the right temporal region. * Intensity is typically 7/10 on a pain scale, sometimes reaching 9/10 during acute episodes. * Associated symptoms include photophobia, phonophobia, and occasional visual aura consisting of flickering lights in her right visual field, lasting 15-20 minutes prior to headache onset. * Aggravating factors include stress, lack of sleep, and bright lights. * Relieving factors include darkness, quiet environments, and over-the-counter analgesics (which are becoming less effective). * Patient reports significant impact on daily activities and work productivity. Past Medical History * Hypertension, diagnosed 3 years ago, well-controlled with medication. * Appendectomy at age 20. Medications * Lisinopril 10mg once daily (for hypertension). * Ibuprofen 400mg as needed for headaches (with diminishing efficacy). Family History * Mother has a history of migraine headaches. * Father had hypertension. Physical Examination * General: Alert and oriented, no acute distress. * Neurological: Cranial nerves II-XII intact. Motor strength 5/5 bilaterally in all extremities. Sensory examination intact to light touch and pinprick. Reflexes 2+ and symmetrical. Cerebellar function intact with normal gait and coordination. No signs of meningeal irritation. Investigations: * Cranial MRI: Performed on 1 November 2024. Normal, no acute intracranial pathology. * Blood tests (FBC, U&Es, LFTs, CRP, ESR): All within normal limits. Summary This 45-year-old female presents with an 8-month history of chronic, progressive, right-sided throbbing headaches associated with photophobia, phonophobia, and occasional visual aura. Past medical history includes controlled hypertension, and family history is positive for migraine. Neurological examination and cranial MRI (1 November 2024) were unremarkable. Diagnostic considerations include chronic migraine, with hemicrania continua as a differential. The management plan aims to confirm the diagnosis, reduce headache frequency and severity, and improve quality of life through a combination of pharmacological and non-pharmacological interventions, with a clear discussion of potential risks and benefits. Plan: * Initiate prophylactic medication: To reduce the frequency and severity of migraine attacks. * Acute abortive therapy prescription: To provide effective relief during acute migraine episodes. * Lifestyle modifications and headache diary: To identify triggers and support self-management strategies. * Follow-up in 4-6 weeks: To assess treatment efficacy and adjust management as needed.