Headache Case Studies Three & Four

Case Study Three

Mary is a 61 year old retired school teacher who presented with a right sided temporal headache that has developed over 5 days.
There has also been pain in her scalp on the same side and last night when she was eating some steak, she developed pain in her jaw. 

 

Over the past few weeks she has had aching muscles in her thighs and upper arms.
She also has some stiffness in her joints and she feels stiff and tired in the mornings when she wakes. 

 

On presentation her BP is 155/90, with a regular pulse. Her heart sounds are normal.
She is afebrile. She has a tender temporal artery on the side of the headache.
There is no abnormality to neurological examination..

Case Study Four

June is a 42 year old teacher who has had a history of DVT and pulmonary embolus after a trip to Europe the previous year.
She was treated with Warfarin for 6 months and the treatment has completed.
Investigations have shown that she has factor V Leiden abnormality and so she will use subcutaneous heparin prior to travel in the future and is avoiding hormone contraception. 

 

Over the past 4 days she has developed a severe generalised headache that is relentless.
Its onset was gradual and is worse when she lies down or strains at the toilet. 

 

Her BP is 145/90 and pulse 90 and regular. ​

 

There are no abnormal findings on neurological examination other than the suggestion of indistinct disc margins bilaterally