The Clinical Problem Solvers
Episode 318: Rafael Medina Subspecialty Series – Headache
Jan 30, 2024
In this episode, the hosts discuss the approach to a new headache, physical exam findings for headache patients, and the workup for headache and suspected giant cell arthritis. They explore the possibility of tuberculous meningitis as a cause of the patient's headache and discuss the role of lab results and MRI in diagnosing giant cell arthritis. The speakers also highlight the management of giant cell arteritis, including the use of IL-6 blockers.
48:36
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Quick takeaways
- Recognizing red flags and considering a broad differential diagnosis are crucial in evaluating a new headache in a patient with a history of migraines.
- Prompt initiation of glucocorticoid treatment is essential in giant cell arthritis (GCA) to prevent irreversible vision loss, and staying updated on glucocorticoid-sparing agents can help minimize long-term steroid use.
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Overview of the Case
This podcast episode focuses on a case presentation of a 74-year-old woman with a history of migraines, meningiomas, Hashimoto's thyroiditis, and a remote history of endometrial cancer. She presents with a new and different headache on the right side of her head and neck, which is not relieved by her usual migraine medications. After further evaluation and imaging, she is diagnosed with giant cell arthritis (GCA) based on abnormal findings in the temporal artery and pathology results from a temporal artery biopsy.
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