AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 32-year-old male presents with recurrent episodes of severe, unilateral, throbbing headache, associated with nausea, photophobia, and phonophobia. These episodes typically last for 4-72 hours and are preceded by visual aura (scintillating scotoma). He reports relief with sumatriptan. What is the most appropriate diagnosis?
- AMigraine with aura
- BTension-type headache
- CCluster headache
- DMedication overuse headache
Show answer & explanationAnswer & explanation
Correct answer: A. Migraine with aura
The patient's presentation with recurrent unilateral throbbing headaches, associated with nausea, photophobia, phonophobia, and especially the presence of a visual aura, is characteristic of migraine with aura as per the International Classification of Headache Disorders (ICHD-3) criteria.
Why the other options are wrong
- B. Tension headaches are typically bilateral, dull, non-throbbing, and not associated with aura, nausea, or severe photophobia/phonophobia.
- C. Cluster headaches are characterized by severe unilateral pain, but typically periorbital, associated with ipsilateral autonomic symptoms (e.g., lacrimation, rhinorrhea), and shorter duration (15-180 minutes), without aura.
- D. Medication overuse headache is a chronic condition caused by frequent use of acute headache medications, and while it might be present, it does not describe the primary headache type or its specific features like aura.
Migraine with Aura
A primary headache disorder characterized by recurrent, severe headaches often preceded by transient focal neurological symptoms (aura).
- Headache: unilateral, throbbing, moderate to severe, exacerbated by physical activity.
- Associated symptoms: nausea/vomiting, photophobia, phonophobia.
- Aura: typically visual (scintillating scotoma, zigzags), lasting 5-60 minutes.
- Duration: 4-72 hours (untreated).
Memory trick: Migraine's a 'Mighty' headache with 'Auras' and 'Nausea'.