AFFILIALATIONS:1Lewis K. School of Medicine at Temple University, Philadelphia, Pennsylvania

2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania


Rubin RN. A 43-year old man suffering from new headaches. Consultant. 2022;62(8):e38-e41. doi:10.25270/con.2022.08.000002


The author has not reported any significant financial relationships.


Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 ([email protected])

A man aged 43 presents after two days of unusual headache. Each of the last two days, he observed blurry vision and flashes of light coming from the left eye. These flashes of light increased for about 30 minutes before being immediately followed by a left-sided headache. The symptoms of vision easing diminished however, the headache continued to be. The patient took Ibuprofen 400 mg that gave significant, but not full pain relief. He experienced a slight nausea however there was no Emesis. There were no additional neurological or ocular symptoms. At the end of the 2nd dayhe felt better and was able to sleep through the night without experiencing pain. The next day, he awoke feeling great, however, later in the day he was experiencing symptoms again that prompted him to go to the clinic.

The history. He is a well-behaved man, with no major medical diagnosis in his history. He exercises regularly. The only medication he takes is occasionally Ibuprofen to treat minor orthopedic problems. There is no history of head injuries or falls is found.

Physical exam. The tests identified vital signs that are that were within the normal range. Particularly the patient was in normal and afebrile. The results of a head eyes nose, ears, and throat exam revealed that his pupils were even, round, responsive in response to illumination and accommodation, and were normal and full of extraocular movements. A fundoscopy that was performed in the office showed no evidence for any obvious retinal hemorrhage and both eyes was normal.

A neurological exam revealed healthy the cranial nerves II-XII without focal or lateralizing symptoms. The routine blood tests (eg the complete blood cell count as well as basic and extensive metabolic panel) were all within normal limits.

Which one of these statements is the most true information concerning the person?

  1. The patient is experiencing onset of the cluster migraine condition.

  2. Initial and aggressive programs to relieve symptoms that contain opioids must be started to stop the development to a more chronic type.

  3. It is suffering from a severe retinal tear and needs immediate referral to an eye doctor.

  4. A diagnosis of migraines is highly likely and treatment using nonsteroidal anti-inflammatory medications (NSAIDs) may be started.

  5. It suffered a throbbing headache and is in need of an urgent Neurosurgical treatment.

Response and discussions on the next page.