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Headache and Facial Pain

A 22-year-old woman reports a scotoma progressing across her left visual field over the course of 30 minutes, followed by left hemicranial throbbing pain, nausea, and photophobia. Her brother and mother have similar headaches. Which of the following is present in this patient's condition but not in common migraine?

a. Photophobia

b. Familial pattern

c. Visual aura

d. Hemicranial pain

e. Nausea

The answer is c. Classic migraine, but not common migraine, is preceded by an aura of neurological dysfunction. The aura is most often visual in nature, consisting of bright flashing lights, scintillating scotomas, or field cuts. Both kinds of migraine are most often characterized by a hemicranial throbbing headache associated with nausea, vomiting, photophobia, and phonophobia (aversion to sound). Familial patterns are not unusual with either classic or common migraine, although with classic migraine the probability that another family member will have a similar problem approaches 80%.

A 16-year-old woman has been having attacks of weakness, blurry vision, and loss of consciousness. The symptoms progress over 20 to 30 minutes, then begin to recede and are followed by a throbbing occipital headache. This patient's symptoms are most likely due to which of the following?

a. Complex partial seizure

b. Common migraine

c. Basilar migraine

d. Transient ischemic attack

e. Orthostatic hypotension

The answer is c. As with classic migraine, with basilar migraine, women are more susceptible than men, disturbances of vision are common, the aura usually resolves within 10 to 30 minutes, and the headache invariably follows, rather than precedes, the neurological deficits; however, the character and severity of neurological deficits associated with basilar migraine are distinct. The visual change may evolve to complete blindness. Irritability may develop into psychosis. Rather than a mild hemiparesis, the patient may have a transient quadriplegia. Stupor, syncope, and even coma may appear and persist for hours.

A 43-year-old woman describes lancinating pains radiating into the right side of her jaw. This discomfort has been present for more than 3 years and has started occurring more than once a week. The pain is paroxysmal and routinely triggered by cold stimuli, such as ice cream and cold drinks. She has sought relief with multiple dental procedures and has already had two teeth extracted. Multiple neuroimaging studies reveal no structural lesions in her head. Assuming there are no contraindications to the treatment, a ...

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