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 are often preceded by visual disturbances, such as flashing lights or zigzag lines. The headaches are associated with nausea, phonophobia, and photophobia. She reports that her mother and sister have similar headaches. What is the most likely diagnosis?
- ATrigeminal neuralgia
- BTension-type headache
- CCluster headache
- DMigraine with aura
Show answer & explanationAnswer & explanation
Correct answer: D. Migraine with aura
The patient's symptoms—unilateral, throbbing headache, preceded by visual aura, associated with nausea, phonophobia, and photophobia, and a family history—are classic for migraine with aura.
Why the other options are wrong
- A. Trigeminal neuralgia causes sudden, severe, shock-like facial pain in the distribution of the trigeminal nerve, often triggered by touch or movement, and is not a generalized headache with aura.
- B. Tension-type headaches are typically bilateral, pressing/tightening (non-throbbing), and not associated with aura, nausea, or severe phonophobia/photophobia.
- C. Cluster headaches are severe, unilateral orbital/supraorbital/temporal pain, but are characterized by autonomic symptoms (e.g., lacrimation, rhinorrhea, ptosis) and typically do not have an aura or throbbing quality.
Migraine with Aura
Migraine with aura is a primary headache disorder characterized by recurrent episodes of severe headache preceded by transient focal neurological symptoms (aura), most commonly visual.
- Aura typically precedes headache by minutes.
- Headache is often unilateral, throbbing, with nausea, photophobia, phonophobia.
- Aggravated by physical activity.
- Family history is common.
Memory trick: MIGRAINE: My Intense, Great, Radiating, Aching, In-head, Nausea, Eye-flashing.