Jenny Taylor

A 35-year-old woman presents to her GP with recurrent severe unilateral headaches preceded by visual aura, with photophobia, phonophobia and nausea. Take a focused history, exclude red flags for sinister headache, examine appropriately, and formulate a management plan.

1. 1Take a focused headache history using SOCRATES
2. 2Characterise the aura and its relationship to the headache
3. 3Actively screen for and exclude red flags suggesting sinister headache
4. 4Perform a focused neurological examination including fundoscopy
5. 5Order targeted investigations where indicated
6. 6State a working diagnosis with relevant differentials
7. 7Initiate acute and preventive management and provide safety-netting