Response – A 37-year-old Patient with Chronic Headaches
Thank you for your detailed presentation on the 37-year-old patient with chronic headaches. You did an excellent job covering the patient’s history, physical examination, and differential diagnoses. However, I would like to offer a few additional insights that could enhance the evaluation and management of this patient.
Firstly, although the differential diagnosis for a headache before meningitis and exclusion of primary headache disorders such as migraine and brain tumor can be based on the lack of photophobia, phonophobia, and increasingly positional headache that is characteristic of the tumor, it is not completely useless to discuss the tension-type headache (TTH). TTH is a primary headache disorder of the first degree, and its manifestation can be very similar to other types of headaches (Shah & Hameed, 2023). In TTH, the patients complain of headaches that are bilateral in location, and may be described as pressing or tightening in character and usually of mild to moderate intensity that is not worsened by physical exertion.
In addition, it might be appropriate to consider stress or other musculoskeletal causes that could potentially cause the patient’s headaches. Stress is among the causes of tension-type headaches, and since the patient works as an accountant, stress or poor working posture could be affecting him/her. Perhaps a comprehensive assessment of the patient’s workplace and his lifestyle, as well as an evaluation of stress and workplace ergonomics at the patient’s workplace, might shed important light. (Stubberud et al., 2021).
As for the management, while the use of over-the-counter medications like acetaminophen and aspirin has provided some relief, the patient could benefit from non-pharmacological interventions such as cognitive-behavioral therapy (CBT) or relaxation techniques to manage stress and potentially reduce headache frequency and intensity (Licina et al., 2023). Additionally, incorporating physical therapy focused on posture correction and ergonomic adjustments could also be beneficial.
More specifically, you have satisfactorily addressed your patient’s differential diagnosis; however, adding other forms of management besides pharmacological that are attached to tension-type headaches could help the patient.
References
Licina, E., AR Radojicic, M Jeremić, Aleksandra Tomić, & Milija Mijajlović. (2023). Non-Pharmacological Treatment of Primary Headaches—A Focused Review. Brain Sciences, 13(10), 1432–1432. https://doi.org/10.3390/brainsci13101432
Shah, N., & Hameed, S. (2023, July 16). Muscle Contraction Tension Headache. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562274/
Stubberud, A., Buse, D. C., Kristoffersen, E. S., Linde, M., & Tronvik, E. (2021). Is there a causal relationship between stress and migraine? Current evidence and implications for management. The Journal of Headache and Pain, 22(1). https://doi.org/10.1186/s10194-021-01369-6
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Response – A 37-year-old Patient with Chronic Headaches
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