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Headaches. 
How many times have you heard 

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somebody say, oh, I've got a 
migraine? 

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Do they really? 
Do they know how debilitating a 

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migraine is? 
Do they know the definition of a

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migraine? 
Which leads me to the 

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differential diagnosis of 
different types of headaches. 

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You've got cluster tension and 
migraines. 

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Wait a minute, differential 
diagnosis? 

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What type of a question am I 
going with here? 

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Case study matrix grid 100% 
patient presents with dot, dot, 

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dot signs and symptoms. 
When people say I've got a 

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migraine and they're able to say
I've got a migraine and they're 

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sitting there doing one of 
these, they don't have a 

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migraine. 
What they've got is a tension 

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headache. 
So what are some risk factors? 

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Risk factors select all apply of
tension headaches. 

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So things like sinus issues, 
dehydration, stress, caffeine 

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withdrawal, so on and so forth. 
So again, these are things that 

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can be resolved. 
So how do I treat it? 

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Well, treat the underlying 
'cause you got stress, get rid 

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of the stress. 
You got caffeine withdrawals. 

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Well, tough it out so you don't 
have them anymore. 

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Or give yourself some caffeine. 
So dehydrated, drink some 

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fluids. 
Tension headaches are going to 

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be something that's bilateral. 
They're probably going to last 

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about 30 minutes to about four 
hours. 

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That's your time frame, but 
treat the underlying cause and 

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it's going to feel like a band 
around your head, like 

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somebody's putting pressure all 
around your head. 

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And how are we going to treat 
it? 

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Well and said acetaminophen 
analgesics, right? 

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So ultimately treat the 
underlying cause. 

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And if you need something a 
little bit more, we've got some 

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pharmacological intervention 
there. 

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So your basic care and comfort 
for this individual is going to 

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be treat the underlying cause, 
hydrate, caffeine, so on so 

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forth, relieve stress, rest, or 
we can give them NSAIDs, 

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acetaminophen. 
The next one is what we call a 

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cluster headache. 
A cluster headache is typically 

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going to be seen in males and 
it's going to be unilateral and 

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it's going to be around the eye 
and it's going to be a sharp 

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pain that happens at the same 
time every single day. 

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This one lasts 15 minutes to 
three hours. 

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And with this we can use one of 
our triptan drugs, so something 

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like Sumatriptan. 
So cluster headaches, again, a 

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differential diagnosis between 
tension, which is going to be 

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your more common one when people
are like, oh, I have a migraine.

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No, you don't, you've got a 
tension headache. 

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Cluster more significant seen in
males and again same time around

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the eye 15 to 15 minutes to 
three hours. 

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But we need to treat this with 
Sumatriptan. 

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Now we get to what is a 
migraine, what people think 

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they're having but they're 
really not unless they truly 

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know. 
When you've had a migraine, 

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typically you've had a history 
of it and it's recurring or it 

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can be triggered. 
So migraines are debilitating. 

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People don't understand how 
sensitive you become to sound 

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and light. 
So photophobia, phonophobia, 

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it's going to be unilateral and 
it's going to last four hours up

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to three days, 72 hours. 
This person's going to want to 

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sit in a dark room, a dark, 
quiet room. 

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So those of you that have ever 
had a migraine, which I haven't,

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but I've treated patients with 
it, they're not going to want to

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leave that dark room. 
And in this situation, again, 

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our option pharmacologically is 
going to be Sumatriptan. 

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We can also use acetaminophen 
and SEDS simultaneously. 

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But with the farm portion of 
this, what we want to know is 

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that we can prophylactically 
treat this. 

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So once a person gets a 
migraine, we know that they're 

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going to get it again. 
It's just inevitable at some 

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point they're going to get 
triggered or it's just going to 

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happen. 
And now we want to 

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prophylactically prevent it. 
And what's a great drug, a 

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cardiac drug you wouldn't think 
is used for neuro, but a cardiac

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drug that we can use 
prophylactically for that 

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migraine? 
Beta blockers. 

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So beta blockers 
prophylactically, like a 

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Propranolol, metoprolol, 
atenolol, you can give it 

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prophylactically in order to 
prevent migraines from 

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happening. 
So when we think about beta 

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blockers, what are we thinking? 
Bronchoconstriction 

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contraindication, Bronchospasm 
contraindication. 

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So what? 
COPD, asthma. 

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And remember, beta blockers do 
what they lower blood pressure, 

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lower your heart rate. 
Even though we're using the 

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prophylactically for migraines, 
but know what they really do. 

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So if we give too much of it, 
look for them to become 

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hypotensive and bradycardic. 
So side effects of beta 

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blockers, never forget those 
because beta blockers are super,

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super high yield. 
And again, we can use a 

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prophylactically for migraines. 
So the differential diagnosis 

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here is cluster unilateral, same
time typically in males treated 

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with Sumatriptan tension, which 
is typically what we talk about 

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when people are like, oh, I got 
a migraine. 

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And these ones are going to be 
things like stress, dehydration,

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caffeine withdrawal, so on and 
so forth. 

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And what are we going to do? 
Treat the underlying 'cause if 

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we need, we can give analgesics.
And then the last one is an 

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actual migraine, which is 
debilitating, 4 hours to three 

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days, photophobia, phonophobia, 
meaning I don't like light, I 

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don't like sound. 
And we're going to treat them 

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with Sumatriptan and SEDS, 
acetaminophen and 

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apophylactically we can give 
them beta blockers. 

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So know those differential 
diagnosis. 

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It's a great bow tie question, a
great case study or a great 

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select all to apply. 
I mean, I can ask it in 100 

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different ways. 
So know those inside out because

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they're super high yield. 
Why they're common, Common 

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medical conditions are high 
yield. 

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So again, super high yield. 
Hope you enjoyed.