A female aged 30, presents with episodic throbbing headache for past 4 yrs. It usually involves one half of the face and is associated with nausea and vomiting. There is no aura. Most likely diagnosis is:
Answer is A (Migraine): Episodic unilateral throbbing headache in a 30 year old female with associated nausea and vomiting suggests a diagnosis of migraine. Aura may or may not be present. Infact 80% of patients with migraine have migraine without aura and 15-20% have migraine with aura. Common Migraine (Migraine without aura) This is characterized by headache with autonomic system dysfunction ( eg. pallor & nausea, vomiting), but without stereotypical neurological or ophthalmic features as in classical migraine Premonitory features include changes in mood frequent yawning or nonspecific prodromal symptoms like loss of concentration Headache stas anywhere in the cranium and is pounding or throbbing It usually spreads to involve one half or even the whole head. During the attack which lasts from hours to a day or more patient is frequently photophobia and phonophobic and seeks relief in quiet dark environment, or through sleep. Classical Migraine (Migraine with aura) This is characterized by headache heralded by a visual aura which lasts about 20 minutes. Visual aura may consist of bright or dark spots, zig zags, heat haze distoions, fig san puzzle defects scintillating scotoma, tunnel vision or foification spectra which may progress to homonymous hemianopia. The headache follows the aura and is usually hemicranial opposite the hemianopia. During the attach patient has associated nausea and photophobia.
Migraine
Cluster headache
Angle closure glaucoma
Temporal aeritis