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SOAP :headaches for the past three months
Case 1( CLICK HELP)
A 25-year-old woman complains of severe headaches for the past three months. They start at one
temple or the other, with pounding pain, and are often accompanied by nausea and vomiting. The
headaches usually last for several hours and occur once or twice a week. She is a schoolteacher and
had to stay home from work one day last month and missed a close friendʼs wedding two weeks ago
because of headaches. She denies associated visual symptoms. On specific questioning, she says she
occasionally missed school as a child due to sinus headaches. Other than asthma, for which she uses
inhalers, she describes her health as good. General and neurological examinations are normal.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses
for one medication you might prescribe, along with an estimate of the cost of a month of your
proposed therapy. How would you counsel the patient about her condition and about any proposed
therapy?
A 25-year-old woman complains of severe headaches for the past three months. They start at one
temple or the other, with pounding pain, and are often accompanied by nausea and vomiting. The
headaches usually last for several hours and occur once or twice a week. She is a schoolteacher and
had to stay home from work one day last month and missed a close friendʼs wedding two weeks ago
because of headaches. She denies associated visual symptoms. On specific questioning, she says she
occasionally missed school as a child due to sinus headaches. Other than asthma, for which she uses
inhalers, she describes her health as good. General and neurological examinations are normal.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.