Head Pains

39 year old female presenting with head pains in occipital and behind mastoid region. The pain
started when the lady was at work. She described the pain as throbbing, and came in waves. She was
not sure how each segment of pain lasted and not sure what exacerbated or relieved the condition.
She had been using cocodamol and paracetamol but there didn’t seem to be any relief in the
condition.

There were no other associated symptoms such as visual problems, photophobia , nausea, vomiting,
dizziness, seizures, joint pain, recent LP

I wanted to make sure I excluded some of the most serious reasons for headache. These were sah,
subdural haematoma.The Patient did not have any focal neurological deficits. From the history I
could rule out Encephalitis and temporal arteritis.

In order to rule out some of these serious cases, my physical examination there was no stiff neck or
photophobia associated with sah and Meningitis. Also there was no complaint of rash .

The gcs was 15. The blood pressure was 164 systolic, and the heart rate was 100.

I wanted to rule out raised icp, and therefore checked if there was papilloedma.

I wasn’t sure if my fundoscopic examination had been through enough. So I asked my supervising
consultant . She examined the patient.

I realised that there were gaps in my learning so I decided to read up about fundoscopy
examinations and so I would feel more confident.

I found some links from the internet, as powerpoint presentations.

www.cvtoolbox.com/downloads/.../Fundoscopic_Examination.ppt

I still feel that I will need more experience and knowledge in this subject.

There was still the issue of the headache. I was advised by my consultant to take bloods for u/e to
check renal function.

Therefore not only did I learn about headaches, but the other relevant examinations one has to do
such as fundoscopy.

Taking a history helps one with the differential diagnosis. For example asking if she had any jaw pain
and also checking if the temporal artery was tender. It was negative on both accounts therefore
leading to the conclusion that she cannot have temporal arteritis.

I still feel I have much to learn about fundoscopy and the abnormalities one has to be aware of which
will take some time.

I found another website which showed me normal and abnormal images. This definitely worth
studying more than once.
http://familymedicine.osu.edu/products/physicalexam/exam/flash/fundoscopic/fundoscopic.cfm

Conclusion

The blood results for this patient were normal. I did the obs and the heart rate was 77 beats , rr was
13. The blood pressure came down to 134. My consultant was happy for this patient to go home with
safety netting advice.