A 55 year old male with a history of hypertension and migraines. He states that he has had a headache for approximately 3 days that came on gradually and is in his mid lower forehead and nose area bilaterally. He also feels neck stiffness and subjective fever but never checked his temperature. He denies any vomiting or photophobia.yesterday his left eyelid was quite droopy, but today it is less so. What is your opinion

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Seems to be a case of Atypical Migraine c Tension headache.Treat c Flunarazine 10 mg HS, Propranolol (dose after BP), Divalproex ER 250 mg HS, gradually dose may be given 500 mg, During attack:Tab PCM+Metoclopramide Stat. & SOS.But pt is hypertensive & stiffness of neck.So must R/O 1 Cervical spondylosis 2 Fibromyalgia 3 Cervical Dystonia 4 Cervical Disc Prolapse 5 Brain tumor 6 SAH 7 Ethmoidal Sinusitis

Thanks Dr Bhawani Prasad Verma
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Seems a case of ophthalmoplegic migraine....

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Probable migraine only. But in view of hypertension better to an MRI brain

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CLASSICAL OPHTHALMOPLEGIC MIGRNOUS ATTACK RESULTING IN L U LID.PTOSIS.

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CLASICAL OPHTHALMOPLEGIC MIGRANOUS ATTACK RESULTING IN L U LID PTOSIS

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My opinion is the migraine can be secondary however would suggest a CT to rule out any primary issues

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Meningitis do CSF examination and mri brain dd lesion in brain dd tb meningitis

The features are suggestive of meningitis. Csf examination should be done to rule out tbm

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MRI over CT?

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? TIA require evaluation bp rbs ct mri

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