Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient reports his headache has increased in intensity over the past few weeks and the pain is unbearable at times. He reports that his headache is located over the right side of his face and is described as a “lightning-like” pain that shoots along his jaw and radiates up to his eyes. He reports the pain only lasts for a few seconds before resolving completely. He has about 10 episodes of pain throughout the day. He is asymptomatic between episodes. He denies prior occurrences of this pain. However, he does notice the headaches tend to occur more frequently when he drinks his morning coffee and when he is shaving. He denies recent head trauma. He denies fever, chills, nausea, vomiting, or fatigue. He also denies neck stiffness, weakness or paresthesias. He denies any history of trauma.
Physical Exam –
General: Male patient appearance consistent with age. Patient is cooperative and pleasant during interview.
Vital Signs: BP:130/80, P:70, RR:18, BMI:30, T:98.9
HEENT: Normocephalic, atraumatic, PEERLA bilaterally. EOM intact bilaterally. No nuchal rigidity. Negative Brudzinski’s sign. Patient is apprehensive when palpated along the right jaw line, which is consistent with the distribution of the pain. Patient reports 1 episode of the pain upon palpation of the right jaw line.
Tests –
CT and/or MRI: normal anatomy, no mass lesions or intracranial hemorrhages