Migraines versus tension headaches

Patient is a 10-year-old girl who is brought in by her father to assess possible allergies to her cats causing increase in sinus complaints and headaches. Patient is a very pleasant 10-year-old who has been suffering from migraines for the last few months. She gets approximately two to four per month and is treating them with caffeine 65 mg and acetaminophen 500 mg when at onset. They are concerned that since they have purchased two kittens for the house approximately one month ago that her headaches have been increasing and they are concerned of cat allergy causing these problems. She also complains of nasal symptoms including itching of the nose, nose rubbing, sore throat, decreased smell and decreased taste and seemed to occur every day. She denies any problem with sinus infection, nasal polyps, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, or frequent tonsillitis in the past. She does have frequent headaches. They tend to be more in the frontal area and temple. She states her nasal symptom is moderate. She has some history of dizziness and lightheadedness occasionally. She was recently diagnosed with Ehlers-Danlos syndrome and has been getting routine checkups for this condition including EKG.

She denies any history of lung problems or asthma. She denies any frequent coughing spells or recurrent night cough or need for albuterol inhalers. She denies any chest infections. She denies any allergic skin problems including hives or atopic eczema currently or in the past. She has never been evaluated for allergies in the past.

ASSESSMENT:
1. Allergic rhinitis.
2. Allergic conjunctivitis.
3. Migraines versus tension headaches.
4. Ehlers-Danlos syndrome.

PLAN:
1. At this time, mom and dad are very interested in allergy immunotherapy for long-term management for reduction of medications need as well as prevention of Atopic March into asthma. They would like to begin as soon as possible.
2. I also encouraged her to use Flonase one spray each nostril one to two times daily to help with any nasal congestion and see if this helps prevent some of her migraine headaches from occurring.
3. I also encouraged her to use Zyrtec 10 mg daily especially when spending frequent time around the cats to help with her allergy symptoms. I also encouraged them to keep the cats out of the bedroom and to use HEPA filtration, vacuum bags, and air filtration to help with reduce allergens exposure.
4. We will follow up for first shot appointment and see how does on allergy immunotherapy.

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