[doctor] Hello?
[patient] Hello.
[doctor] Hello there. It's uh Doctor here. How can I help you this afternoon?
[patient] Ohh, I just got a terrible headache since mid-day.
[patient] Um on the left side. It's just making me feel so ill. I just feel like I need to vomit.
[doctor] I'm sorry to hear that. Um can you tell me a bit more about the headache?
[patient] Well you know, I noticed some zig-zag lines in my vision a few minutes before the headache started.
[doctor] Mm-hmm.
[patient] My vision blurred. Um, you know, it just
[patient] I, yeah. Pain's just horrible. Just making me feel so unwell. Um
[doctor] Mm, OK. And
[patient] just want you to do something.
[doctor] Well, let's try our best. Let's try and get you, let's try and get you well, soon. Um you mentioned it's on your left hand side. Is that right? And it started at mid-day, a few hours ago.
[patient] Yeah.
[doctor] OK. Um did the pain come on quite suddenly? Or was it more of a gradual build up?
[patient] Don't know, really. It just happened.
[doctor] OK. And are you able to describe what kind of headache it was? For example, was it throbbing, or was it more of a sharp pain?
[patient] Yeah, I guess it's, yeah I guess it's throbbing, um on that left side.
[doctor] And is it moving anywhere else, at all?
[patient] No, but it's worse when I move.
[doctor] Uh OK. Is that when you move your neck?
[patient] Well, like if I lean forward, or like move my head or neck, yeah, headache gets worse.
[doctor] OK. Um
[patient] I'm just really worried. Like I've just been googling and like I've read, you know if your headache gets worse if you move, it could be a sign of brain cancer.
[doctor] OK. Is that all you're worried about?
[patient] cancer.
[doctor] Is that, is that all your main worries today?
[patient] Ohh yeah, yeah and I'd like, you know
[patient] My, my friend's mum, she she recently died of a brain tumor. So, it's really concerning me actually.
[doctor] Oh dear, I'm sorry to hear that. I can, I can understand why it's affecting you. Um
[doctor] But why don't we, why don't we take a good history first, and let me examine you. And then we can have a little chat afterwards, and see what's going on here.
[doctor] Um so you mentioned a few things. You mentioned a headache. You also mentioned some disease, like Lyme's, uh before the headaches came on.
[doctor] And your vision has been blurry as well. Is that right? Is that , is that on both eyes, or just in left, left eye?
[patient] Yeah.
[patient] Eh, feels like it some days.
[doctor] Both eyes, OK. Have you any difficulty with seeing bright lights, at all?
[patient] Yeah well I'm , wearing sunglasses right now. It's just, you know, the light's really hurting my eyes.
[doctor] Ohh, I see OK. Um and you mentioned that you felt quite nauseous. Have you vomited at all?
[patient] Yeah.
[patient] I vomited twice.
[doctor] Twice, OK. Um earlier today, OK. Um, any temperatures or fevers?
[patient] Um, no I don't feel feverish.
[doctor] OK. Um, any other funny skin rashes that you may have noticed?
[patient] No, I haven't noticed anything like that.
[doctor] OK. Um fine. Um, and do you normally get headaches?
[patient] Um, I'm not really prone to them, no. No but I did, I did have a similar headache a few weeks ago.
[doctor] OK. And what happened then?
[patient] Just similar.
[doctor] How long did it last for?
[patient] Couple of days.
[doctor] Did you do anything that made it better?
[patient] Um yeah I had to take painkillers, and had to go go to bed and rest and
[doctor] Yeah.
[patient] couple days off work, and I work in the fashion industry. And you know, they're wondering what's going on, like I have to take sick days.
[doctor] Yeah. Yeah.
[patient] I need to get back to work today. But you know, what if it is a brain tumour? What's gonna happen with my future and my career?
[doctor] Yeah. Yeah.
[patient] You know, really about this. never had headaches like this before. Like why should I get them now?
[doctor] Yeah, sure. I mean I can see your concern obviously is a lot, there's a lot of worry there.
[doctor] Um but you know let let let, as I said let's take it step by step, um to see exactly what the cause of these headaches are first. Um, I'm just going to ask you some, um very uh yes no questions if that's OK, ma'am. Um
[doctor] Um have you noticed any problems with your speech at all, any difficulties with your words?
[patient] No.
[doctor] Any problems with your arms and legs? For example numbness or weakness?
[patient] No.
[doctor] Any difficulty with balance, your balance or coordination?
[patient] No.
[doctor] OK. And have you had any injuries to your head? Have you had a fall recently, or been knocked on the head?
[patient] No.
[doctor] OK, alright. Um and and you're feeling otherwise OK. So, for example your um
[doctor] Uh your your breathing's OK? You're not feeling breathless, or
[doctor] No, OK. Um do you have any other medical history I should be aware of?
[patient] No, nothing.
[doctor] No. So for example, have you had, has anyone told you you've had migraines in the past?
[patient] No.
[doctor] No, OK. Do you
[patient] No. My mum, my mum has, has migraines. But I've, I've not been diagnosed.
[doctor] OK.
[doctor] Right, my next question was that of family history. Is there anything in the family? So apart from migraines, is there anything else? Is there anything related to brain, for example?
[patient] as well.
[doctor] What was that, sorry?
[patient] My mom has an underactive thyroid as well.
[doctor] thyroid as well. OK. Um OK any other problems with for example, the brain, or? Um you mentioned brain cancer. Any other family history of ?
[patient] No.
[doctor] No, OK. Um in terms of medications, do you take anything on a regular basis?
[patient] Um I take the pill, Microgynon.
[doctor] OK. And how long have you been on that for?
[patient] three months.
[doctor] Three months, OK. And is that mainly for contraception, or is that for something else?
[patient] it's for contraception.
[doctor] OK, alright.
[doctor] That's something you meant to have a little discussion about today as well. Um
[doctor] Uh well my next question was about um your social, your situation at home. You mentioned you work in the fashion industry.
[doctor] And your work, is your job quite stressful at the moment?
[patient] Yeah it's really stressful, actually.
[doctor] Have you been
[patient] having problems at like work, you know managers like putting a lot of pressure on me to deliver and, uh yeah it's not a good time.
[doctor] . Is it getting you down?
[patient] I don't feel down, just a little bit stressed.
[doctor] OK, alright. And what kind of things do you do to alleviate your stress, normally?
[patient] Nothing really.
[doctor] OK. Do you do much in the way of exercise?
[patient] No.
[doctor] No, OK. Um who's at home with you?
[patient] Um, I live on my own.
[doctor] OK. Um are you coping OK at the moment?
[patient] Fine.
[doctor] Yeah? OK. Um do you smoke at all? and do you drink much in the way of alcohol?
[patient] No.
[patient] No.
[doctor] OK, alright. Um, so normally at this I'd like to kind of proceed to examination. Um
[doctor] That's um based on your story, um I wonder whether you may, uh may have a migraine, uh migraine type headache. Uh it sounds
[doctor] Um, very classical of that, of that nature, the the the headache on one side, throbbing nature, the nausea, vomiting, um sensitivity to bright lights.
[doctor] Uh, I'm reassured that you don't have anything more serious, such as meningitis, or indeed
[doctor] Brain cancer, I know that was a big worry of yours initially. Um
[patient] thank you, uh thanks so much. I was so worried that I had cancer. And, ohh now you say migraine. Yeah I guess my mum has similar symptoms to me and yeah, it does make sense.
[doctor] yeah. Yeah.
[doctor] Well, I hope that puts your, you know, mind at ease. Um, certainly this is the second migraine you've had in the space of a month. Um,
[doctor] So I think, moving forwards, there's a couple of options. I think keeping a headache diary would be quite important, uh to see exactly what's triggering these headaches.
[doctor] And in terms of trying to treat your headaches today, some strong painkillers would be advisable. So, think about Paracetamol, or even Co-codamol.
[doctor] Um, and some anti-inflammatories, such as Ibuprofen and Naproxen. How's that sound to you?
[patient] K that sounds good.
[doctor] Um and uh, you know if your headaches were to become more persistent, then we could maybe think about giving you some medications that will stop your headaches from happening in the first place, something prophylactic medicines.
[doctor] then we could have a discussion next time I see you next week, perhaps.
[patient] OK.
[patient] OK.
[doctor] OK. Um, now a couple of things I want you to think about is, you know if your symptoms aren't getting better next two three days, or indeed they're getting worse.
[doctor] I'd like you to come back and see me, um straight away if possible. So if your headache's getting worse, not responding to medications
[doctor] Or your um neck pain is getting worse, or you develop any weakness in your arms and legs, or your vision, then I want you to come back and see me straight away. OK?
[patient] OK.
[doctor] Does that sound all OK?
[patient] Doctor, that's great.
[doctor] Great. Any questions for me?
[patient] No. Thank you.
[doctor] OK. Have a good day!
[patient] K thanks. Bye!
[doctor] Right.

Medical orders:
description: Paracetamol
order_type: medication
reason: wonder whether you may, uh may have a migraine
description: Co-codamol
order_type: medication
reason: wonder whether you may, uh may have a migraine
description: Ibuprofen
order_type: medication
reason: wonder whether you may, uh may have a migraine
description: Naproxen
order_type: medication
reason: wonder whether you may, uh may have a migraine
description: next time I see you next week, perhaps
order_type: followup