Differential Diagnoses 1- Cerebral Aneurysms: Cerebral aneurysm or intracranial

1-     Cerebral
Aneurysms: Cerebral aneurysm or intracranial
aneurysm, accompanied with or without “subarachnoid hemorrhage (SAH)”, is a pertinent
health issue. When a rupture of an intracranial aneurysm happens, it is a
critical concern for the patient’s health (Jeong, Seo, Kim, Jung & Suh, 2014).
2-     Cluster
Headache: Cluster headache (CH), is
the most common of the “trigeminal autonomic cephalalgias (TAC)” and is
described as the most painful of the primary headache disorders. It affects
patients with “attacks of severe, strictly unilateral pain, which is orbital,
supraorbital, temporal, or in any combination of these sites, lasting 15–180
minutes and occurring from once every other day to eight times a day” (Gooriah,
Buture & Ahmed, 2015).
3-     Exertional Headache:
Exertional headache is considered one of the rare headache syndromes that take
place either as a primary or secondary headache as a result of an underlying
disease. Cautious assessment for the underlying cause is of extreme
importance for this uncommon type of headache (Lance & Goadsby, 2005).
1-     Migraine: when a patient is
having a migraine, the temporal artery enlarges or dilates. This artery lies just
outside the skull and just under the temple. This expansion elasticities the
nerves that are looped around the temporal artery and causes them to discharge
chemicals that can cause inflammation, pain, and even greater expansion of
the artery. When the artery grows larger, the pain gets worse (McCance,


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Educate the patient about migraine and the treatment
available. Encourage the patient to keep a diary. The purpose of
the diary is to assist her in identifying triggers, precipitating events
and risk factors that will help her in tracking evolvement of treatment
approaches (Gooriah,
Buture & Ahmed, 2015).Encourage patient to practice stress management.The patient does not drink coffee and encourage not
to start.Initiate nonpharmacological therapies for this
patient. It should be considered for the prevention of migraines. These
therapies may help alleviate her symptoms because she has a poor
tolerance to drug therapy, Examples of nonpharmacological therapies can
be relaxation training and cognitive-behavioral therapy (Gooriah,
Buture & Ahmed, 2015).

Zofran 4
mg by mouth every 6 hours as needed for nausea/vomiting.
Fiorocet (BUTALBITAL 50mg,
Dosage form: capsule) One capsules every four hours PRN for headache.  Total daily dosage should not exceed 6
capsules (Silberstein, Holland, Freitag, Dodick,  Argoff & Ashman, 2012).
Follow up
appointment. RTC in 2 weeks
4-     Referral considerations: refer to
neurologist (Lance & Goadsby, 2005).

Gooriah, R., Buture, A., & Ahmed, F. (2015).
Evidence-based treatments for cluster headache. Therapeutics and Clinical
Risk Management, 11, 1687–1696. http://doi.org/10.2147/TCRM.S94193
Jeong, H. W., Seo, J. H., Kim, S. T., Jung, C. K.,
& Suh, S. (2014). Clinical Practice Guideline for the Management of
Intracranial Aneurysms. Neurointervention, 9(2), 63–71. http://doi.org/10.5469/neuroint.2014.9.2.63
Lance, J., W &
Goadsby, P., J (2005). Mechanisms
and management of headaches.
7th ed. Oxford: Butterworth –
McCance, K. L., & Huether, S. E. (2010). Pathophysiology:
the biologic basis for disease in adults and children (6th ed.).
Maryland Heights, MO: Mosby Elsevier.
Ravishankar, K., Chakravarty, A., Chowdhury, D.,
Shukla, R., & Singh, S. (2011). Guidelines on the diagnosis and the
current management of headache and related disorders. Annals of Indian
Academy of Neurology, 14(Suppl1), S40–S59.
Silberstein, S. D., Holland, S., Freitag, F.,
Dodick, D. W., Argoff, C., & Ashman, E. (2012). Evidence-based guideline
update: Pharmacologic treatment for episodic migraine prevention in adults:
Report of the Quality Standards Subcommittee of the American Academy of
Neurology and the American Headache Society. Neurology, 78(17),
1337–1345. http://doi.org/10.1212/WNL.0b013e3182535d20