Age: 23.0
Sex: F
Vaccine: COVID19
Symptoms: Abdominal pain, Angiogram cerebral normal, Blood test normal, Botulinum toxin injection, Computerised tomogram abdomen normal
Clinical narrative: Summary: prior to vaccination, patient had approx. 3 headache days/month. For over a year after vaccination, patient had 27-30 headache days/month. Currently (2 years and 8 months after vaccination), patient still has 15+ headache days/month and significant limitations: cannot exercise at all without triggering a migraine, and screentime remains a trigger - patient uses assistive device on her laptop (ePaper/eInk screen attachment) to do work online.  July 2020 (prior to vaccination): diagnosis with episodic migraine. 1/16/2021: first migraine since vaccination: severe headache (treated with Tylenol and Excedrin) followed by severe abdominal pain (attempted treatment with Ondansetron) requiring an emergency room visit (abdominal pain rated 8/10). Treatment at emergency room consisted of fluids, Reglan, Benadryl, and Toradol through IV. Discharged same night with resolution of pain. 1/16/2021 to 1/19/2021: severe abdominal pain persists, along with vomiting. Pain is so intense that despite normal bloodwork the patient's primary care orders and abdominal CT with contrast to rule out appendicitis. Abdominal CT is normal. 1/21/2021: abdominal pain continues, patient has not been able to eat anything since 1/16/21 so the patient's neurologist directs the patient to go to the emergency room again for fluid repletion. At the ER, patient is given fluids, toradol, benadryl, compazine, and dexamethasone by IV. ER doctors are willing to admit the patient if she cannot keep down some crackers ? the patient is able to, and is discharged same day. 1/22/2021 to 2/2021: abdominal pain shifts to head pain. Patient suffers from extreme photophobia and spends days lying in the dark, nauseous and with head pain. Patient seeks guidance from primary care doctor, neurologist, and gastroenterologist. Patient is started on new medications for preventing and aborting migraine, including topiramate and trying out various triptans. 2/5/2021: second COVID shot, Moderna.  2/2021 to 4/2021: continuous headache pain, every day. 4/2021: started on a preventative migraine medication given as a self injection (Emgality). 5/2021 to 7/2021: patient begins to feel some periods of relief from headache pain. However, she still feels headache pain nearly every day. 8/2021: severe migraine flareup lasting several weeks and requiring another visit to the emergency room. After this episode, patient is back to near continuous pain. 9/2021: patient begins trigeminal and occipital nerve blocks every three weeks. 9/2021 to 1/2022: number of headache days per month decreases slightly. 1/29/2022: beginning of another very intense three week flare for which patient was prescribed a short steroid taper, given Toradol and a emergency nerve block, and underwent a brain MRI and MRA due to the longevity and severity of my condition. Brain imaging was normal. 2/2022: patient and neurologist agree to stop trigeminal and occipital nerve blocks due to lack of benefit. spring 2022: patient started on metoprolol as migraine preventative. injectable medication switched from emgality to aimovig due to perceived lost of effectiveness of emgality. decrease in headache days. 01/2023: begin botox treatments. Patient currently has about 18 headache days per month and has occasional (monthly) episodes of migraines that may require missing work for a day. 09/2023: patient continues to use botox, aimovig, metoprolol, and topiramate as preventative medication. Patient uses Tylenol and naratriptan as abortive medication. Patient has about 15 headache days per week when adhering to limitations including no exercise (including walking for long distances) and limited screen time. Patient has suffered mental health worsening due to persistent disability.