Migraine Without Aura

Migraine Without Aura

S – Subjective Data

Chief Complaint (CC)

“I have suffered a terrible headache for the last 3 days.”

History of Present Illness (HPI – OLDCARTS Format)

The case is of a 32-year-old girl who visited the emergency department with a history of a gradually increasing headache.

  • Onset: Gradual onset, began 3 days ago
  • Location: Frontal region
  • Duration: Persistent, lasting several hours daily
  • Characteristics: Throbbing, pulsatile pain
  • Aggravating Factors: Bright light, noise, and stress
  • Relieving Factors: Rest in a dark room; partial relief with paracetamol
  • Timing: Worse in the afternoon and evening
  • Severity: 8/10

Associated Symptoms

  • Nausea
  • Photophobia
  • No vomiting

These findings are consistent with migraine diagnostic features

Current Medications

  • Paracetamol 500 mg PRN

Allergies

  • No known drug allergies (NKDA)

Past Medical History (PMHx)

  • No chronic illnesses
  • No surgical history

Family History (FH)

  • Mother has a history of migraines
  • Father has hypertension

Social History (SH)

  • Non-smoker
  • Occasional alcohol use
  • Works in a high-stress office environment

Review of Systems (ROS)

  • General: Fatigue present, no fever
  • HEENT: Headache present, no visual loss
  • Cardiovascular: No chest pain
  • Respiratory: No shortness of breath
  • Gastrointestinal: Nausea present
  • Neurological: Headache, no weakness or seizures
  • Psychiatric: Reports stress

O – Objective Data

Vital Signs

  • Temperature: 36.8°C
  • Blood Pressure: 118/76 mmHg
  • Heart Rate: 78 bpm
  • Respiratory Rate: 16 breaths/min
  • SpO₂: 98%

Physical Examination

  • General: Alert, oriented, mild distress
  • HEENT: Pupils equal and reactive to light
  • Neurological: No focal deficits
  • Cardiovascular: Normal heart sounds
  • Respiratory: Clear lungs

Objective findings show no neurological abnormalities, supporting a primary headache disorder rather than a secondary cause.

A – Assessment

Primary Diagnosis: Migraine Without Aura

Rationale:

The patient presents with a unilateral, pulsating headache of moderate-to-severe intensity, associated with nausea and photophobia. These features meet the diagnostic criteria for migraine without aura (Pescador & Jesus, 2024).

Differential Diagnoses

  1. Tension-Type Headache

Typically bilateral and non-pulsating, with no nausea or photophobia, making it less likely.

  1. Cluster Headache

Characterized by severe unilateral orbital pain with autonomic symptoms, which are absent in this patient (Xu et al., 2024).

  1. Sinus Headache

Associated with nasal congestion and facial pressure, which are not present.

P – Plan

Pharmacological Management

  • Ibuprofen 400–600 mg PRN
  • Consider Sumatriptan for acute migraine

Triptans are first-line therapy for moderate to severe migraines (Goadsby et al., 2025).

Non-Pharmacological Management

  • Rest in a dark, quiet room
  • Stress management strategies
  • Maintain regular sleep patterns

Patient Education

  • Identify and avoid triggers (stress, light, poor sleep)
  • Maintain hydration and a balanced diet
  • Keep a headache diary

Follow-Up

  • Review in 1–2 weeks
  • Return immediately if symptoms worsen

References

‌ Goadsby, P. J., Sinclair, A. J., Afridi, S. K., Lucas, C., Mawet, J., Lanteri-Minet, M., Moisset, X., Diener, H. C., Gaul, C., Jürgens, T. P., Sumelahti, M.-L., del Rio, M. S., del Pozo-Rosich, P., Russo, A., & Barbanti, P. (2025). Moderate to Severe Acute Migraine Attacks: An Opinion Paper on the Use of Triptans and Triptan-NSAIDs Combinations in Individualized Treatment Plans. Neurology and Therapy, 15(1), 15–28. https://doi.org/10.1007/s40120-025-00874-z

‌ Xu, X.-H., Li, Y.-M., Ren, L.-N., Xu, X.-F., Dai, Y.-L., Jin, C.-Q., & Yang, R.-R. (2024). Cluster headache: understandings of current knowledge and directions for whole process management. Frontiers in Neurology, 15. https://doi.org/10.3389/fneur.2024.1456517

Pescador, M. A., & Jesus, O. D. (2024, July 5). Migraine Headache. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560787/

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WEEKLY RESOURCES

To prepare:

• Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource provided via the Help button located in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
• Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor.
Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
• Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
• Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
• Ensure that you have the appropriate lighting and equipment to record the presentation.

Video Assignment for this week’s presenters:

Record yourself presenting the complex case study for your clinical patient. In your presentation:

• Dress professionally with a lab coat and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
• State 3 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
• Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
• Report normal diagnostic results as the name of the test and “normal” rather than specific values. Abnormal results should be reported as a specific value.
• Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
• Be succinct in your presentation, and do not exceed 8 minutes.

A note on grading:

• Presenters: Review the Grand Rounds Presenter Rubric attached to this discussion to ensure you meet the scoring criteria.
• Participants: Review the Grand Rounds Participant Rubric located on the following Week 4 Assignment 1 page to ensure you meet the scoring criteria. Note the Week 4 Assignment 1 page is for viewing the rubric only; your responses should be posted in the forum of this page.