A 33-year-old woman experiences visions of flashing lights followed by throbbing left-sided temporal pain and nausea. The most likely diagnosis is:
The typical migraine attack consists of a visual aura with flashes, scintillating scotomata (field loss), or foification spectra followed by a throbbing unilateral temporal headache. There may be associated vestibular, GI, or neurological symptoms. Attacks are often precipitated by stress, fatigue, or foods that contain tyramine (eg, cheese, yogu, nuts) or phenylethylamine (wine, chocolate). Symptoms peak within an hour of onset and persist for hours to days. A positive family history is found in as many as 50% of cases. Tension headaches are more often bilateral and described as "band-like" or "vise-like" and are not usually associated with visual auras. TIAs more typically present as a transient monocular blindness without aura or headache. Cranial aeritis may present as painless loss of vision without aura. Meningoencephalitis is associated with nuchal rigidity and diffuse headache but not with visual auras. Acute treatment of migraine headache consists of ergotamine tarate, antiemetics, and analgesics. Prophylactic medications such as propranolol, dipyridamole, and methysergide are ineffective for acute attacks. Avoidance of known precipitants and control of stress are also impoant in prevention. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 10. Headache and Other Craniofacial Pains. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.
Tension headache
Transient ischemic attack
Cranial aeritis
Migraine headache