Headache and Eye Pain
Authors:
Scott W. Melanson, MD
James Raftis, DO
Affiliations:
Emergency Medicine Residency of the Lehigh Valley
St. Luke's Hospital
Bethlehem, PA (SWM, JR)
Chief Complaint:
Migraine headache
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History of Present Illness:
A 20-year-old female college
student presents to the emergency department (ED) with 4 day history
a of right-sided, throbbing headache, similar to previous migraine
headaches only more severe. Photophobia and nausea, without vomiting
are present. She developed swelling of her right eyelid only today.
She was treated for the diagnosis of migraine headache with meperadine
100 mg IM on two previous ED visits within the past two days.
Review of systems are positive for an 8 day history of rhinorrhea,
nasal congestion and a mild, nonproductive cough. The patient
denies fever or change in vision.
Physical Examination:
The patient is an alert female in moderate discomfort. Vital
signs are normal except for a rectal temperature of 100.7oF.
Visual acuity is 20/25 and 20/20 in the right and left eyes respectively.
The patient's head showed no evidence of trauma and is non-tender
to palpation. There is no tenderness to sinus percussion. The
right upper and lower eyelids are edematous and erythematous (Fig.
1). There is proptosis of the right eye. (Fig. 2). Extraocular
muscle function is normal but causes severe pain with eye movement
in all directions. Slit-lamp examination, reveals minimal conjunctival
injection, but normal cornea and anterior chamber. The funduscopic
examination is normal. The neck is supple without signs of meningismus.
Neurologic examination is normal. The remainder of the physical
examination was unremarkable.
Laboratory:
The hematocrit was 35.7% and
the white blood cell count was 19,300 cell/mm3 with 87% segs,
9% lymphs and 4% bands. A maxillofacial CT was obtained (Fig.
3 and 4).
The patient course, diagnosis and discussion
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