[Music] now for patients who present with a migraine this is a very common presenting symptom to the emergency department this is something that we see relatively frequently migraines are chronic causes of headaches and can be very incapacitating to patients so patients who have a history of severe migraines can get very severe headaches that limit their ability to get worked on to interact they most commonly begin in the second decade of life and there is a genetic component so patients will often relate to the fact that their parents or brothers or sisters have similar headache symptoms that they experience patients with migraines can present with lots of different symptoms a common one is that they may have an aura associated with their headache and what we mean by an aura is that they may see spots prior to their headache or they may have other sensations that they experience prior to their headaches or when their headaches are first beginning patients with migraines also can present with a handful of other symptoms so common things that patients have are photophobia which is when bright lights will bother patients the classic thing that you sometimes may see is patients who present with migraine headaches may come into the emergency department wearing sunglasses even though it’s kind of dark outside so at night that’s a classic sign of patients who have migraine headaches phono phobia is when loud noises might bother patients as well as nausea and vomiting may be associated with migraine headaches in extreme cases patients may also present with neurologic abnormalities with their migraine headaches such as dizziness and actually patients may experience weakness as well and really might mimic very closely a stroke so sometimes when these patients present with those symptoms especially if they don’t have a headache of migrant history of migraine headaches you definitely can sometimes be a little bit confused or trying to sort out whether or not this is a migraine or a more serious neurologic problem so what should we do for these patients so for some patients you may need to get some neural imaging so you might need to get a head CT for patients who have a new headache so they say that I’ve never had a headache like this for for patients who are immunocompromised patients who are on medications that might suppress their immune system or patients who have underlying diseases that can make them be immunocompromised the classic one being HIV or AIDS any kind of neurologic abnormalities such as weakness numbness tingling problems with their ambulation potentially promiseth speech might prompt you to get neural imaging and then sudden onset of headache is the other thing that might make you more concerned or point you in that direction now if a patient has a prior history of similar symptoms and they come in and they say this feels very similar to my migraine that I’ve had before that definitely kind of puts you or points you in that direction that this is in fact most likely a migraine headache [Music]

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