Migraine Headache

NO is a 30 year old Saudi female who presents to the clinic at today for her appointment with a chief complaint of a migraine headaches at least
twice a week for the past 2 months. She states that she considers this current headache as moderate and has not been able to go to work for the
past 2 days. When the migraines occur, she remains in the bed with her room completely dark for the en re me requiring assistance from her
mother or maid to move. Her migraines are with an aura that last around 30 minutes and are described as unilateral throbbing head pain. She
has signi cant nausea and vomi ng. She has used acetaminophen and naproxen with success, but is worried about her liver and kidneys with
frequent use throughout the week (2 to 3 days around the clock).

Past medical history: Hypertension

Social history: Single, working for a pharmaceu cal company; she doesn’t adhere to any diet or exercise; she smokes 1 pack per day; she denies
alcohol, and/or illicit drug use.
Family history: her mother has a history of migraines and her father is healthy. She also has two sisters who are healthy.
Immuniza ons: up to date
Allergies: NKDA

Medica ons
Acetaminophen 1000 mg every 6 - 8 hours for migraines
Naproxen 500 mg daily for migraines

Physical Examina on
Gen
WDWN woman in mild distress
VS
BP 142/86 mm Hg, HR 76, RR 18, T 37.2°C; Wt 75 kg, Ht 5ʹ3ʺ
Skin

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 Normal skin turgor; no diaphoresis

HEENT
PERRLA; EOMI; no funduscopic exam performed
Neck
Supple; no masses, thyroid enlargement, adenopathy, bruits, or JVD
Chest
Good breath sounds bilaterally; clear to A&P
CV
RRR; S1, S2 normal; no murmurs, rubs, or gallops
Abd
So , NT/ND, no hepatosplenomegaly; (+) BS
Genit/Rect
Deferred
MS/Ext
UE/LE strength 5/5 with normal tone; radial and femoral pulses 3+ bilaterally; no edema; no evidence of thrombophlebi s; full ROM
Neuro
A&O × 3; no dysarthria or aphasia; memory intact; no nystagmus; no fascicula ons, tremor, or ataxia; (–) Romberg; CN II–XII intact; sensory
intact; DTRs: 2+ throughout; Babinski (–) bilaterally

Lab tests: (Fas ng)

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 Lab Today
WBC 8.5 X10^9/L
Hgb 14.4 gm/L
Hct 40%
Platelet 350 X10^9/L
Di eren al WNL
ALT 25 IU/L
AST 23 IU/L
Alk phos 35 IU/L
BUN 12 mmol/L
Crea nine 84 mmol/L
Sodium 142 mmol/L
Potassium 4.2 mmol/L
Chloride 1.01 mEq/L
Glucose 95 mg/dL
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