NR 603 Week 6 Collaboration Cafe_Clinical Education Associates CEA Pre-Diagnostic Case Study Part 1..

• Familial Hx: Mother and sister are prone to tension migraines. • Social Hx: Non-smoker, denies recreational/IV drug use, drinks 2-3 cocktails 3- 4x weekly with coworkers to help decompress after shifts • Allergies: NKDA Risk Factors Associated with Chief Complaint: Stress, insomnia, alcohol misuse, dehydration, poor daily nutritional intake, SD contraceptive, hx of GAD, genetic predisposition to tension headaches. 3 Common Differential Diagnoses Associated with Chief Complaint (Prevalence/Pathophysiology/Clinical Presentation/Rationale): 1. Tension-type Headache (TTH): o Prevalence- As per Onan et al. (2023), the prevalence of tension-type headaches among U.S. adults is reported to be as high as 43% resulting from several genetic and environmental factors. o Pathophysiology- According to Onan et al. (2023), the exact mechanism of the pathology is not fully understood. However, TTHs are believed to be caused by peripheral myofascial nociception in episodic cases and by central sensitization in chronic cases. The transition from episodic to chronic TTH involves both peripheral and central mechanisms (Onan et al., 2023). In addition, clinical manifestations of TTH are correlated in patients with sleep disturbances, psychiatric comorbidities, and mental distress disorders further attributing to overall autonomic dysfunction and thus resulting in the onset of TTH (Onan et al., 2023). o Clinical Presentation- Mild to moderate head wrapping pain without visual/auditory disturbances typically lasting from 1 hour to 1 week and resolves with reduction/mitigation of triggering factors. o Rationale- Diagnosis of TTH is determined by the presence of cardinal symptoms including a band-like pressure, dull pain located bilaterally on the head without nausea, vomiting, and visual or auditory disturbances (Onan et al., 2023). Notably, the patient’s given risk factors of female sex, familial disposition to TTH per her mother and sister histories, poor nutritional status, lack of optimal sleep, and psychological factors such as poor stress management as evidenced by her coping mechanism with alcohol misuse are all contributable and convincing reasons for her presenting symptoms. Therefore, it is appropriate to suggest she is suffering from an acute onset of TTH in contrast to the other corresponding differentials. 2. Migraine w/o aura: o Prevalence- According to Onan et al. (2023), the prevalence of migraines without auras are three times higher among women in comparison to men at approximately 33% of U.S. women in America. Furthermore, migraine prevalence peaks in late teens-early 20s with an additional peak during a woman’s highest reproductive years, although, symptoms are exacerbated during cardinal signs and symptoms of acute sinusitis aside from complaints of a frontal headache, it is noteworthy to consider still consider the diagnosis in that 60% of a-typical presenting sinusitis cases are often mis-diagnosed until indication for CT scan of head/sinus cavities is obtained (Kim & Patel., 2020). Additionally, migraine and TTHs can often be confused with headaches from acute rhinosinusitis due to similar pain locations such as the frontal sinus and, in migraines, accompanying nasal symptoms (Kim & Patel., 2020). The presence of purulent nasal discharge and other specific features help differentiate these conditions (Kim & Patel., 2020). Furthermore, since the patient does not