Neurology · Model history
A severe one-sided headache: a model history
- Setting
- Neurology urgent clinic
- Patient
- Ms. Yoon, 28, has had a severe right-sided throbbing headache for 24 hours after seeing flashing lights.
- Listen
- 4 min
After listening
Say the next question
Read the patient’s answer, say your next question aloud, then reveal the model.
“Usually once or twice a month. This one feels like my usual attack, but it has lasted longer and has kept me from working.”
Ask one question that checks acute-medicine use and possible medication overuse.
What have you taken for it, and how often do you use pain medicine in a typical month?
Model interview
Full transcript
- Doctor
Ms. Yoon, I'm Dr. Rivera. I can see the light is bothering you, so we'll keep the room dim. Tell me what happened with this headache.
- Patient
It started yesterday. I saw flashing lights, and about half an hour later I got a strong throbbing pain on the right side of my head.
- Doctor
How did the pain build up?
- Patient
It became strong over maybe twenty minutes. It wasn't like a sudden explosion.
- Doctor
How severe is it now, and has it let up during the past twenty-four hours?
- Patient
It's about eight out of ten. It eased a little while I slept, but it never fully went away.
- Doctor
Describe exactly what you saw before the pain began.
- Patient
There were flickering, flashing spots across my vision. They gradually spread and then cleared after about twenty minutes.
- Doctor
Was that visual experience the same as with your earlier headaches?
- Patient
Yes. I've had the same warning before several of my headaches since I was a teenager.
- Doctor
What other symptoms came with this attack?
- Patient
I feel nauseated, and I vomited twice. Light and ordinary sounds feel unbearable.
- Doctor
Have you had any new weakness, numbness, trouble speaking, confusion, or loss of vision?
- Patient
No. The flashing stopped before the pain settled in, and I haven't had any of those other problems.
- Doctor
Any fever or a stiff neck?
- Patient
No.
- Doctor
Did this follow a head injury, heavy exertion, or a new medicine? Do you have cancer or a condition that weakens your immune system?
- Patient
No. Nothing unusual happened before it started, and I don't have cancer or an immune condition.
- Doctor
How often are these headaches occurring now, and has their usual pattern changed?
- Patient
Usually once or twice a month. This one feels like my usual attack, but it has lasted longer and has kept me from working.
- Doctor
What have you taken for it, and how often do you use pain medicine in a typical month?
- Patient
I took ibuprofen yesterday, but it didn't help. I only use it on headache days, usually once or twice a month.
- Doctor
Do you have any other medical conditions or take any regular medicines?
- Patient
No. I'm generally healthy and don't take anything regularly.
- Doctor
Do you have any medication allergies?
- Patient
None that I know of.
- Doctor
Because pregnancy can affect which causes and treatments we consider, is there any chance you could be pregnant?
- Patient
No, there isn't.
- Doctor
What are you most concerned about, and what help were you hoping for today?
- Patient
I'm worried these attacks will keep disrupting my design work. I'd like something that can stop them when they start.
- Doctor
Let me summarize. You developed your usual gradually spreading visual warning, followed thirty minutes later by a right-sided throbbing headache with vomiting and sensitivity to light and sound. The attack was not instantly severe, and you report no fever, stiff neck, injury, or new neurologic symptom. It resembles attacks you have had since adolescence, although it has lasted longer and ibuprofen did not help. Have I understood that correctly, and is there anything else I should know?
- Patient
That's correct. I don't think I've left anything out.
- Doctor
I'll check your vital signs and perform a focused neurologic examination before we decide what evaluation and symptom relief are appropriate. If the pattern changes suddenly or you develop weakness, trouble speaking, confusion, fever, or a stiff neck, that needs urgent reassessment.
- Patient
Okay. That makes sense.
Flow at a glance
The route through the history
- Reduce sensory discomfort and invite the story
- Establish onset and time to peak
- Characterize the visual symptoms and headache
- Compare with prior attacks
- Screen for secondary-headache warning signs
- Review acute medication and relevant background
- Explore work impact and treatment goal
- Summarize and give a pattern-change safety net
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Editorial record
Tied to one reviewed case
This model uses a fictional Bedside English case as its source. The page and pre-generated WAV audio are checked against the same transcript and source-case fingerprints.
Editorial update: