Turn off the lights please
If our patient reported headaches that lasted at least 4 to 72 hours (without treatment or with unsuccessful treatment) and has at least two of the following symptoms: Unilateral location, Pulsating quality, Moderate or severe pain intensity, Aggravation by or causing avoidance of routine physical activity, then this condition would be high on your list
What is a migraine? (Could consider retinal migraine)
This condition should jump to the top of your differential diagnosis list if our patient were to complete a blood test showing positive results for IgG antibodies against water channel proteins on astrocytes aquaporin-4 (AQP4-IgG) Hint: think of hiccups
What is neuromyelitis optica?
Commonly associated with area postrema syndrome, which can cause long-lasting hiccups
Given our patient's age, risk factors, and presentation, this is the most likely diagnosis. Hint: think about the TIMELINE of her symptoms
What is multiple sclerosis?
This condition would could be at the top of our differential list if our patient's symptoms were accompanied with symptoms of transverse myelitis and/or acute disseminated encephalomyelitis (Hint: autoimmune)
What is MOGAD (myeline oligodendrocyte glycoprotein antibody-associated disease) ?
If our patient's exam showed bilateral papilledema, she undergoes a lumbar puncture with an elevated opening pressure, and her CSF shows no evidence of infection, inflammatory, or malignant processes, then this diagnosis could be very likely (Bonus: what are the patient's risk factors pointing towards this diagnosis?)
What is idiopathic intracranial hypertension?
Risk factors: Oral contraceptive use, young woman