Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with recurrent episodes of severe, unilateral, pulsating headache associated with photophobia, phonophobia, and nausea. Onset is gradual, duration 4-72 hours. Patient reports exacerbation with physical activity and relief with rest in a dark, quiet room. No focal neurological deficits, aura, or red-flag symptoms noted.
Clinical Examination Findings
General appearance: Patient appears in distress due to pain. HEENT: Normocephalic, atraumatic. Pupils equal, round, and reactive to light. Extraocular movements intact. No meningeal signs (nuchal rigidity absent). Neurological: Cranial nerves II-XII intact. Motor strength 5/5 bilaterally. Sensory exam intact to light touch. Gait and coordination normal.
Treatment Protocol
Initiate abortive therapy with NSAIDs (e.g., Ibuprofen 800mg) or Triptans (e.g., Sumatriptan 50mg) at onset of symptoms. Advise hydration and rest in a dark, quiet environment. Consider prophylactic therapy if frequency exceeds 4 days per month. Follow-up in 4 weeks to assess efficacy and side effects.