From the Guidelines
For this 67-year-old patient with band-like headaches, I recommend continuing acetaminophen as needed since it provides partial relief, but limiting use to no more than 3000mg daily to prevent liver toxicity, as suggested by the American College of Physicians guideline on pharmacologic treatments of acute episodic migraine headache in outpatient settings 1. The patient should keep a headache diary to identify triggers, particularly noting the correlation with egg consumption which suggests a possible food sensitivity. Given the band-like quality and recent onset in an older adult, I recommend scheduling neuroimaging (preferably MRI) to rule out secondary causes of headache such as temporal arteritis, especially considering the patient's age. Complete the requested cholesterol panel as part of a comprehensive metabolic workup. The patient should return for follow-up in 2 weeks if symptoms persist or worsen despite acetaminophen use. While the patient currently declines medication beyond acetaminophen and refused a ketorolac injection, consider discussing non-pharmacological approaches such as stress management techniques, adequate hydration, and regular sleep patterns. The band-like quality of the headache could indicate tension-type headache, but the recent onset in an older adult necessitates ruling out secondary causes. The exacerbation with eating eggs is unusual and warrants further investigation into possible food sensitivities or allergies. According to the American College of Physicians guideline, clinicians should consider treating mild episodic migraine headache with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1. However, given the patient's current relief with acetaminophen and refusal of other medications, continuing acetaminophen as needed is the most appropriate course of action. It is also important to note that the patient's symptoms do not currently warrant the use of triptans or other pharmacologic treatments, as recommended by the guideline for moderate to severe acute episodic migraine headache 1.
From the Research
Patient Presentation
- The patient is a 67-year-old female presenting with a 1-2 week history of band-like headaches rated 5-10/10 on the pain scale.
- The headaches are exacerbated by movement and after eating eggs.
- The patient reports partial relief with acetaminophen and no radiation of pain.
Diagnostic Considerations
- There is no direct evidence from the provided studies to support a specific diagnosis for the patient's headaches.
- However, the patient's symptoms could be related to various conditions, and further evaluation may be necessary to determine the underlying cause.
Laboratory Tests
- The patient has requested a cholesterol check, which may be relevant to her overall health but not directly related to her current symptoms.
- A complete blood count (CBC) may be useful in assessing cardiovascular and metabolic diseases, as suggested by 2.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be helpful in monitoring inflammatory conditions, as discussed in 3.
Patient Communication and Management
- The patient has denied wanting medication and has refused a toradol injection, indicating a preference for non-pharmacological management.
- The patient's anxiety score has been discussed, and she has reported that acetaminophen helps relieve her pain.
- A patient-centered approach to communication, as described in 4, may be helpful in understanding the patient's perspective and concerns.
- Avoiding defensive medicine, as discussed in 5, is essential in providing individualized care and avoiding unnecessary interventions.
Additional Considerations
- The patient's symptoms do not appear to be related to concussion, as discussed in 6, since there is no mention of trauma or injury.
- Further evaluation and monitoring may be necessary to determine the underlying cause of the patient's headaches and to develop an effective management plan.