This scenario concerns a 42-year-old female who has experienced headaches for the past three months that are relieved only by four to six hours' rest in darkness. Every few weeks she experiences a sensation that she may fall while walking, and she has actually fallen twice. She also experiences "a funny sensation" in her feet and hands which persists for one to two weeks at a time. Her family history includes a grandfather unable to get out of bed for several months at the turn of the 20th century, undiagnosed.
The photophobia is a classic migraine symptom, so this patient should have an electroencephalogram as well as a CT scan of the head and neck and be assessed for migraine headaches (Van Gerpen, Hickey, & Capobianco, 2000). She should also be asked what medications she is on, since vasodilators, hormones, anti-hypertensives, histamine-2 blockers, antibiotics, and selective serotonin reuptake inhibitors could trigger migraines and might also bear a relation to the funny sensation in her feet (Van Gerpen, Hickey, & Capobianco, 2000).
The patient should also be assessed for abnormal symptoms that may indicate a diagnosis in addition to or in lieu of migraine that is more serious. Evaluation of neck flexion to check for meningitis; the presence of bruits over the cranium, orbits, or neck; the optic fundi and visual fields, as well as papillary reactions; the fifth cranial nerve's sensory function; corneal reflexes; facial and limb motor power; stretch reflexes of muscles; plantar responses; and gait can all indicate serious conditions that should be followed up on if results are abnormal (Pryse-Phillips, Dodick, Edmeads, Gawel, Nelson, Purdy, Robinson, Stirling, & Worthington, 1997, p. 1276). The funny sensations in feet and hands could be related to diabetic neuropathy, and the patient should be checked for that as well as intermittent claudication, although the latter generally resolves in min
...