NeurologyResidents

Example for a headache note 

Headache history: 
Mr. B is a 45-year-old right handed man who is presenting to the clinic today for follow up for migraine. Patient started to have significant headache at age of 25. Initially it was mild/moderate in severity and occurred around once a month then increased in frequency over the years to almost 3-4 episodes of severe headache per week. He used to take OTC analgesics prn to control his headache initially till he was diagnosed with migraine at age of 30 and started on migraine medications as noted below.

Interim history: 
Last clinic visit, patient was started on topiramate for prevention that was gradually increased to 50mg bid and naproxen 500mg bid prn. Patient reports decrease in headache frequency over that past few months to once a

Headache description:
-Character: pressure like headache, starts in the back of the head then spreads to involve both frontal regions.
-Aura: visual in the form of bright spots and zigzag lines 10 minutes before the headache
-Asscociated symptoms: nausea but no vomiting, sensory phobias
-Frequency: currently once a month
-Increased by: skipping a meal, artificial sweeteners, physical stress
-Decreased by: staying in dark quiet place.
-Other manifestations of migraine: no symptoms suggestive of POTS,  no palpitation or chest pain, no change in bowel habits.

Current medications: 
Abortive: Naproxen 500 mg bid prn
Preventive: Topiramate 50 mg bid

Previously tried medications: 
Abortive:  hydroxyzine stopped due to significant sedation.
Preventive: magnesium oxide didn't work at 500 mg bid

Plan:
- Migraine abortives: continue on Naproxen 500 mg bid prn
- Migraine preventives: will increase topamax to 50 qam and 75 qpm
- Discussed the potential side effects of the current medications, patient was understanding and agreeable.

- Migraine counselling:
- patient was instructed to take the abortive medications once the headache starts.
- He was advised to stay in a calm quite place during headache.
- Discussed the need to avoid common migraine triggers (artificial sweeteners, food preservative (MSG), aged cheese, skipping meals, change in wake/sleep cycle and intense physical exertion)
- Lifestyle changes that help migraine: physical exercise, fixed meal time, fixed sleep/wake cycle, avoid smoking and highly caffeinated products.
- Patient was advised to avoid OTC analgesics which can increase migraine frequency and can cause medication overuse headache.

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Migraine resources

>> Diagnostic criteria for migraine

>> Migraine prints for patient counselling 

>> Headache diary 

Medications for prevention: 

Topiramate - magnesium oxide - valproate - propranolol - timolol - candesartan - amitriptyline - nortriptyline - verapamil - botulinum toxin

Medications for abortion: 

Triptans - NSAIDS (naproxen - ibuprofen - ketorolac) - Prochlorperazine - Hydroxyzine - Metoclopramide - DHE

Trade names: 

Naproxen salt preparation: Naprosyn

Naproxen sodium: Aleve - Naprelan - Anaprox (not as effective as the salt form)

Further details will be added soon !