Concluded Case

Is this Migrane?

24M c/o of pulsatile throbbing pain like sensation radiating from neck to occiput and to the bilateral temporal region, vertigo Aggravated on moving head and in spine position, on extension of neck , Relieved by sleeping in prone position, Pt had a similar complaints 2 yrs back , relieved on medication, Past medical hx - he was on METX 25mg bcz of HTN Mild Past Medical hx - No past surgical hx Personal hx - Sleep cycle - irregular because of complaints and he used to sleep with a pillow with flexed neck for a long time, Does this cause any compression to the neck?? Non alcoholic, Non smoker , Bowel and Bladder -Normal On Examination- He was pallor with NO signs of icterus, cyanosis, clubbing , Lymphadenopathy ,edema Vitals- Febrile, Pulse - 90/min , BP on SITTING - FLUCTUATING over a range of systole 110 - 140mm Hg/ Diastolic 80-90 mm Hg RS- clear , Vesicular breath sounds CVS - S1 S2 heard, NO RISE IN JVP , No added sounds , CNS - all reflexes normal, gait - Normal But Movement in neck is restricted bcz of stiffness and vertigo IS IT MIGRAINE OR STRESS HEADACHE??? Diagnosis??? TREATMENT?? Can I suggest CLONAZEPAM 0.5mg + Propronolol20mg for 2days??(CLONAFIT)??

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Concluded answer
Young male patient. THROBBING PULSATILE HEAD ACHE RADIATING FROM NECK TO OCCIPITAL AND TEMPORAL REGIONS with vertigo aggravated on moving the head There is nothing to suggest migraine.Something is missing in the history. The history provided here in favour of cervicogenic head ache.This is not the age for cervical spondylosis. This patient should ref to Neurologist for proper evaluation. Young pt ,a CVJ anomaly has to exclude. NEEDS MRI CERVICAL SPINE and the Neuologist will decide the investigations.
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SUGGESTIVE OF CERVICAL SPONDYLITIS DD MIGRAINE
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Young male patient. THROBBING PULSATILE HEAD ACHE RADIATING FROM NECK TO OCCIPITAL AND TEMPORAL REGIONS with vertigo aggravated on moving the head There is nothing to suggest migraine.Something is missing in the history. The history provided here in favour of cervicogenic head ache.This is not the age for cervical spondylosis. This patient should ref to Neurologist for proper evaluation. Young pt ,a CVJ anomaly has to exclude. NEEDS MRI CERVICAL SPINE and the Neuologist will decide the investigations.
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A case of cervical spondylitis. This pain is due to cervical spondylitis- Points in favour are . 1.Pain radiating from neck to occiput 2.Vertigo is common in cervical spondylitis- 3.Aggravated by head and spine movements 4.Relieved in Prone position Although in D/D 1 Migraine 2.Tension headache Get a X- ray - cervical spine Treatment- Tab Aceclofenac + Thiocolchicoside 4 mg B.D for 7 days . A PPI Tab Vertin 16 mg B.D for 7 days Avoid use of pillow
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Pulsatile throbbing pain suggest vascular headache since it is post headache relieved in prone posture It may be hypertensive headache Migraine A-V FISTULA OR ANEURYSM NEEDS MRA TO STUDY THE CAUSE He should continue metaprolol Aspirin Tranquillisers Sos tagretol200mg at bed time Investigate him in detail
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Cervical spondylosis.. Neither it seems to be Migraine Or Stress head ache.. Cervical color....Physio exercise..B12... If vertigo is a problem Proclopromezine 10 mg.
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As per history may be MIGRAINE, CERVICAL SPONDYLITIS, Aneurysm so ask for CBC ESR Blood SUGAR CERVICAL X RAY AP and Lateral view
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Looks like cervical spondylosis Could be stress/migraine headache too Need x-ray and blood investigation
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Suspected case of cervical spondylitis and root compression
What is the treatment for spondylitis
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Yes Migraine with Tension headache Add Flunarazine 10mg hs
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Migraine headache D/D Cervical spondylitis Ad M R I
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