NU621 Unit 6 DQ 1: headache case and post-stroke care
Answer two cases: describe headache pathology and match an etiology to James's 15-year history of unilateral burning pain with tearing and rhinorrhoea, then build a plan of care and secondary prevention goals for Mr. Smith, three months after a stroke with no records available.
Editorial process
Last reviewed · August 13, 2026
A supplied diagnosis, and a patient with no records
Case one is more interesting than it first looks. James has fifteen years of severe, strictly unilateral burning headache with ipsilateral tearing and rhinorrhoea, attacks several times a day lasting about an hour, in bouts separated by months of freedom. That constellation — unilateral, short, autonomic features, clustered in time with remission periods — is the textbook description of cluster headache, not of migraine. The prompt then tells you that using the headache chart you diagnose migraine without aura and asks you to list the evidence supporting that diagnosis. Work through the pathology and the etiologies honestly first, because the question sequence asks for those before it hands you the label. Then list what in the history would point toward migraine and be candid about what does not fit. Naming the trigeminal autonomic features and the circadian bouts shows the diagnostic reasoning the question is actually testing.
Case two turns on the missing records, and that constraint should shape the whole plan of care rather than being mentioned and set aside. Mr. Smith had a stroke three months ago in another state, his records are unavailable, his wife reports he has not been acting right, and she believes he has no hypertension while noting that he avoids doctors. So you do not know the stroke subtype, the imaging, the discharge medications or whether risk factors were assessed. The plan therefore begins by establishing that baseline: history, examination including a cognitive and functional assessment given the wife's concern, blood pressure, lipids, glucose and rhythm assessment, and an attempt to obtain the outside records. Only then do the prevention goals follow. The brief points you at the AHA/ASA antithrombotic recommendations for noncardioembolic stroke, so frame the goals in their terms — antithrombotic therapy, blood pressure and lipid targets, glycaemic control and lifestyle change — with numbers where the guideline gives them.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Describe the pathophysiology underlying primary headache disorders.
- 02Match headache etiologies to a specific symptom pattern including autonomic features.
- 03Identify the history and examination findings that would refine a headache diagnosis.
- 04Construct a plan of care for a stroke survivor whose records are unavailable.
- 05Apply current antithrombotic and risk-factor guidance to secondary stroke prevention goals.
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Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
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Turn the brief into deliverables
- 01A description of headache pathology.
- 02An identification of which etiologies fit James's presentation.
- 03Additional history and physical examination elements that would aid diagnosis.
- 04A list of evidence supporting the migraine without aura diagnosis the prompt states.
- 05A detailed plan of care for Mr. Smith with guideline-based prevention goals.
Pathology, etiology, history, evidence — then the plan
Headache pathology
The mechanisms underlying primary headache, set up so the etiologies can be compared.
Which etiology fits James
Compare candidate etiologies against unilateral pain, autonomic features and bout pattern.
History and examination that would help
The specific additional data that would separate the remaining candidates.
Evidence for the stated diagnosis
What in the history supports migraine without aura, and what sits against it.
Mr. Smith: establishing the baseline
The assessment required because no records, imaging or medication list is available.
Secondary prevention goals
Antithrombotic, blood pressure, lipid, glycaemic and lifestyle targets from current guidance.
Headache classification and secondary stroke prevention
Recommended databases
- StatPearls via NCBI Bookshelf
- MedlinePlus
- PubMed
- AHA/ASA guideline linked in the assignment
- Course pathophysiology text
Search sequence
- 1.Read the clinical descriptions of cluster headache and of migraine side by side.
- 2.Note which autonomic features are specific to trigeminal autonomic cephalalgias.
- 3.Read the current secondary prevention recommendations for noncardioembolic stroke or TIA.
- 4.List the diagnostics needed when a stroke survivor arrives with no records.
- 5.Collect numeric targets for blood pressure, lipids and glycaemic control.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Cluster Headache
StatPearls, NCBI Bookshelf · 2024
The presentation that matches James's history most closely, including autonomic features and bout pattern.
- 02
Migraine Headache
StatPearls, NCBI Bookshelf · 2024
Diagnostic criteria for migraine without aura, needed to list the evidence the prompt asks for.
- 03
Transient Ischemic Attack
StatPearls, NCBI Bookshelf · 2024
Risk stratification and secondary prevention principles after ischaemic events.
- 04
Stroke
MedlinePlus, National Library of Medicine · 2024
Authoritative overview of stroke risk factors underpinning the prevention goals for Mr. Smith.
Review before submission
Common mistakes
- Describing headache in general without ever reasoning about James's specific pattern.
- Accepting the supplied diagnosis without listing which features do and do not support it.
- Overlooking the autonomic features — tearing and rhinorrhoea — that carry the diagnostic weight.
- Writing a stroke plan that assumes facts the missing records could have supplied.
- Setting prevention goals with no numeric targets from the guideline.
- Ignoring the wife's report that he has not been acting right, which is itself a finding.
Submission checklist
- All questions posed in both cases are answered.
- The headache etiologies are matched to features in James's history.
- The evidence list for the stated diagnosis is explicit.
- The plan of care begins by establishing the unknown baseline.
- Prevention goals cite the current AHA/ASA recommendations.
- Claims are supported by peer-reviewed sources in APA format.
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Aaron Bishop
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