59 Year Old Female: Intermittent Head Pain

One of my co-workers told me that she wants to see more case studies. A 59-year-old female presents to the emergency department with a chief complaint of “head pain that comes and goes.” She describes the pain as a dull ache in her occiput that’s been striking without warning a couple of times per day for the past ten days. Over the last three days she’s noted that it has also been radiating into her neck and upper back/shoulders. Onset – 10 days prior Provocation/Palliation – None that she can identify Quality – Dull ache that gradually worsens over the first few minutes Radiation – Sometimes to her neck and upper back/shoulders Severity – Around 9 out of 10 at its worst Timing – Intermittent, each episode lasting ~10–15 minutes Signs/Symptoms – A well-appearing 59yo F in no acute distress; symptoms as described above. She denies any associated nausea/vomiting/shortness-of-breath/lightheadedness/palpitations/syncope, but has occasionally experienced blurred-vision. Allergies – No known drug allergies Medications – Metformin, sitagliptin, insulin glargine, lisinopril Past Medical History – Type II diabetes mellitus, hypertension, occasional migraines, appendectomy (40 years prior) Last Oral Intake – Dinner three hours prior to arrival Events Preceding Presentation – She experienced another spell at dinner and it self-resolved, but then a few hours later it came back and disappear...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Cases Vince DiGiulio Source Type: research