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2 results

  • Case 19 - A 23-Year-Old Female with a Headache

  • from Section 2 - The Cases
  • Joshua Lowe, San Antonio Military Medical Center, Rachel Bridwell, Uniformed Services University of Health Sciences, John Patrick, San Antonio Military Medical Center, Alec Pawlukiewicz, Carl R. Darnall Army Medical Center, Gillian Schmitz, Uniformed Services University of Health Sciences, Michael Yoo, University of Texas Health San Antonio
  • Book:
    ThinkER: Transitioning to the Emergency Medicine Mindset
    Published online:
    01 March 2026
    Print publication:
    19 March 2026, pp 138-142

  • Summary

    This clinical vignette features a 23-year-old female college student presenting with a gradual-onset, left-sided, throbbing headache accompanied by photophobia, phonophobia, and nausea. With stable vitals and no focal neurologic deficits, her history and physical exam are consistent with a primary headache disorder, likely migraine. The case illustrates a methodical approach to ruling out serious secondary causes of headache, such as subarachnoid hemorrhage, meningitis, encephalitis, cerebral venous sinus thrombosis, and toxic exposures, through targeted history, neurological exam, and pregnancy testing. The absence of red flags allows for a clinical diagnosis of migraine and the initiation of evidence-based symptomatic therapy, including IV fluids, antiemetics, NSAIDs, and rescue therapy with droperidol. This case emphasizes the importance of differentiating benign from life-threatening etiologies in young adults and reinforces key diagnostic and therapeutic strategies in migraine management within the emergency department.

  • Migraine and benign paroxysmal positional vertigo: a single-institution review

  • M Teixido, A Baker, H Isildak
  • Journal:
    The Journal of Laryngology & Otology / Volume 131 / Issue 6 / June 2017
    Published online by Cambridge University Press:
    02 March 2017, pp. 508-513
    Print publication:
    June 2017
    • Article
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  • Background:

    Benign paroxysmal positional vertigo and migraine-associated dizziness are common. The prevalence of benign paroxysmal positional vertigo seems to be higher in patients with migraine-associated dizziness than in those without migraine.

    Methods:

    A database of 508 patients seen at the primary author's balance clinic was analysed to determine the prevalence of migraine, as defined by International Headache Society criteria, in patients with benign paroxysmal positional vertigo.

    Results:

    The percentage of patients with dizziness or vertigo who met criteria for migraine was 33.7 per cent, with a prevalence of benign paroxysmal positional vertigo of 42.3 per cent. When excluding patients with migrainous vertigo, patients with migraine frequently had benign paroxysmal positional vertigo (66.7 per cent vs 55.8 per cent), although this finding was not statistically significant.

    Conclusion:

    The results for the entire sample suggest that, after excluding patients with migrainous vertigo, patients with migraine seem more likely to have benign paroxysmal positional vertigo; however, this association was not significant, probably because of the small sample size.