Case Study: JL
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JL, a 21-year-old male approaches you, the pharmacist, and asks, "What can I take for my headache?" You ask the patient about his symptoms and he comments that he has been studying for his final exams all week. “I felt like my head was going to explode this morning.” JL goes on to describe the pain being dull now vs. hours earlier and that his pain index is 4/10. JL has not taken any over-the-counter medicines but did try resting and lying down for several minutes, which helped some. However, as JL continued to study and read thereafter, his headache resumed again. You ask JL to describe where the pain is in his head and if it had spread to anywhere else. JL points to his head and also neck and shoulder area.
PmHx: Ulcer
ALL: NKDA
Current medications: Prilosec OTC®
- Using the QuEST method, quickly and accurately assess JL
- Using the SCHOLAR-MAC method, classify the pertinent information illustrated in this case
| Symptoms | Original pain was head exploding |
|---|---|
| Characteristics | Dull consistent pain 4/10 |
| History | Tried resting before presenting today |
| Onset | Early this morning |
| Location | Head and radiates to neck and shoulders |
| Aggravating factors | Reading and studying |
| Remitting factors | Resting, lying down |
| Medications | Prilosec OTC |
| ALL | NKDA |
| Comorbidities | PUD |
Using the QuEST method, establish if this patient is an appropriate self care candidate. Provide
a rationale:
- No severe symptoms
- No symptoms that persist or return repeatedly
- Not self-treating to avoid medical care
If this patient is a self care candidate, suggest appropriate strategies (QuEST) for JL. Include
supportive measures with your recommendations:
- Since this patient has a history of ulcer disease, it is not appropriate to recommend an NSAID to treat his headache
- Appropriate treatment would be to suggest acetaminophen
- General care measures: Rest and sleep, ice pack, try to relax and manage stress and try to avoid triggers
If recommending self care, talk with JL regarding 2-3 counseling points (QuEST)
- Acetaminophen 325-500mg every 4-6 hours (<4 grams/day)
- Used for pain relief but no anti-inflammatory activity
- Take with full glass of water. Avoid alcohol
- Adverse effects are rarely seen (anemia and blood dyscrasias)
When can the patient expect relief from symptoms?
- Should see some pain relief within 30-60 minutes.
When should JL seek his primary care provider?
- If symptoms worsen, do not get any better, or become intolerable, he should call his provider
- If they persist for more than 10 days he should also call his provider