AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 32-year-old female presents with a 2-month history of intermittent, severe, unilateral, throbbing headaches that last 4-72 hours. She reports nausea, photophobia, and phonophobia during these episodes. Before some headaches, she experiences visual disturbances, including shimmering lights and zigzag lines, lasting about 20-30 minutes. What is the most likely diagnosis?
- ATension-type headache
- BMigraine with aura
- CCluster headache
- DTrigeminal neuralgia
Show answer & explanationAnswer & explanation
Correct answer: B. Migraine with aura
The patient's description of severe, unilateral, throbbing headaches with associated nausea, photophobia, and phonophobia, preceded by transient visual disturbances (shimmering lights, zigzag lines), is classic for migraine with aura.
Why the other options are wrong
- A. Tension-type headaches are typically mild to moderate, bilateral, pressing/tightening, and lack associated features like nausea, photophobia, or aura.
- C. Cluster headaches are excruciatingly severe, unilateral, orbital/temporal pain, but are shorter in duration (15-180 minutes) and associated with autonomic symptoms (lacrimation, rhinorrhea, ptosis) rather than a visual aura.
- D. Trigeminal neuralgia causes sudden, severe, electric shock-like facial pain in the distribution of the trigeminal nerve, triggered by touch or movement, not a throbbing headache with aura.
Migraine with Aura
A type of migraine headache preceded by transient neurological symptoms, most commonly visual, that typically last 5-60 minutes before the headache phase.
- Headache is usually unilateral, throbbing, severe, with nausea, photophobia, phonophobia.
- Aura symptoms are reversible, often visual (scotomas, zigzag lines), but can be sensory or motor.
- Aura typically precedes the headache but can occur during or even after.
Memory trick: MIGRAINE: Migraine Is Generally Really Awful, Involves Nausea, and Eye-sensitive.