Summary
Highlights
A patient named Eve, born on March 2, 1990, presents with severe headaches that have been ongoing for approximately six months. She describes them as debilitating and is concerned about their cause.
The headaches typically occur on one side of her head (left or right) and are described as a deep, throbbing, pounding sensation. They build gradually over minutes and can last for hours or even an entire day/night. She experiences nausea but no vomiting, and no neck stiffness.
Eve notes her headaches are sometimes triggered by tiredness, stress, or the start of her menstrual period. They occur once or twice a month, mostly in the afternoons. Bright lights and loud noises worsen the pain. On a scale of 0-10, she rates the pain as an 8, sometimes a 10, highlighting its severe impact on her life. Over-the-counter painkillers like paracetamol and ibuprofen have been ineffective.
Before a headache, Eve feels tired, irritable, and yawns excessively. Immediately before, she experiences visual disturbances like flashing/flickering lights and zigzag lines. After the headache, she feels 'washed out', tired, and drained for a day or two.
Eve is worried about the headaches, fearing they might indicate 'something more sinister' like a brain tumor. She hopes to understand the cause and receive stronger painkillers. Her medical history includes well-controlled depression with Citalopram and she uses the mini-pill for contraception. Her mother also has a history of bad headaches and breast cancer.
Eve works as a dental nurse and lives with her boyfriend. She doesn't smoke or use recreational drugs but drinks about six small glasses of wine per week. The headaches have occasionally caused her to miss work.
The doctor summarizes Eve's symptoms, focusing on the unilateral, throbbing nature, associated nausea, triggers, severity, and impact on her life. Eve's main concerns about a serious underlying cause are acknowledged. The doctor plans to perform a full neurological and cardiovascular examination and consider further investigations, including a headache diary.