| Course | NU 611 Clinical Decision-Making |
|---|---|
| Unit | Unit 2 |
| Paper type | Differential diagnosis paper |
| Length | About 1,100 words, 7 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 611 Unit 2
A New Headache Pattern in a 38-Year-Old Woman: Arguing the Differential
Student Name
Department of Nursing, Herzing University
NU 611: Clinical Decision-Making
Instructor Name
January 27, 2026
A New Headache Pattern in a 38-Year-Old Woman: Arguing the Differential
The Presentation
A composite 38-year-old woman, a pharmacy technician, presents to primary care with headaches that have changed over the past five weeks. She has had occasional headaches since her twenties, about one a month, which she treats with ibuprofen. Over the past five weeks the headaches have occurred four to five days a week. They are bilateral, pressing, worse at the end of the workday, and moderate in severity; on two occasions she had a throbbing one-sided headache with nausea and light sensitivity that forced her to lie down. She now takes ibuprofen or an acetaminophen-aspirin-caffeine combination on most days. She started a combined oral contraceptive four months ago. She reports no sudden-onset headache, no fever, no weakness, and no change in vision other than light sensitivity during the two severe episodes. Her examination, including fundoscopy, blood pressure of 122/78, and a complete neurologic examination, is normal. Body mass index is 26.
Candidates in the Order They Arose
Tension-type headache entered first, because the dominant daily pattern is bilateral, pressing, moderate, and worse at the end of work. Supporting it: the quality, location, and severity of most episodes match the diagnostic criteria for tension-type headache in the International Classification of Headache Disorders (Headache Classification Committee of the International Headache Society [IHS], 2018). Against it: two episodes were unilateral, throbbing, and accompanied by nausea and light sensitivity, which tension-type headache does not explain. Verdict: retained as the explanation for most daily headaches but not for the whole picture.
Migraine without aura entered with those two severe episodes. Supporting it: unilateral location, pulsating quality, activity-limiting severity, nausea, and photophobia together meet the features of migraine (IHS, 2018), and a woman with a long history of occasional headaches is in the typical age group. Against it: migraine does not explain the near-daily pattern on its own. Verdict: retained, probably as a coexisting disorder rather than the sole diagnosis.
Medication-overuse headache entered when the medication history was counted. Supporting it: she uses simple analgesics or a combination analgesic on most days, and the frequency of her headaches increased during the same five weeks her use increased. The classification requires regular overuse for more than three months, with combination analgesics counted as overused at ten or more days a month (IHS, 2018). Against it: at five weeks, the duration criterion is not yet met. Verdict: retained as an emerging risk that the plan must address, not as a confirmed diagnosis.
Cerebral venous thrombosis entered because she started an estrogen-containing contraceptive four months ago and her headaches changed afterward. It is uncommon, but it is dangerous and can present with headache alone. Supporting it: the timing of the change relative to the new medication. Against it: no papilledema on fundoscopy, no focal signs, no seizures, and a pattern that fluctuates with the workday rather than progressing steadily. Verdict: lowered but explicitly not ignored, because the SNNOOP10 list of warning features includes a new or changed headache pattern and headache related to a new medication or hormonal change (Do et al., 2019).
Idiopathic intracranial hypertension entered because of her age, sex, and recent weight change. Supporting it: demographics. Against it: normal fundoscopy, no pulsatile tinnitus, no transient visual loss, and a body mass index of 26 rather than in the obese range. Verdict: removed, with the fundoscopy finding named as the reason.
Subarachnoid hemorrhage was considered because every changed headache pattern invites the question. Against it: no sudden onset reaching peak intensity within a minute, no neck stiffness, no exertional onset, and no loss of consciousness. The Ottawa subarachnoid hemorrhage rule is designed for acute headache peaking within an hour in the emergency setting and was not met on any criterion (Perry et al., 2013). Verdict: removed.
Ranking and Its Criteria
The ranking below orders candidates primarily by likelihood, with one exception made for danger. First, tension-type headache with coexisting migraine without aura, supported by two distinct phenotypes within the same history. Second, evolving medication-overuse headache, likely enough and consequential enough that the plan must act on it now rather than wait for the three-month criterion. Third, cerebral venous thrombosis, placed third not because it is likely but because its consequences justify keeping it visible until the contraceptive question is resolved.
Ordering purely by likelihood would have pushed cerebral venous thrombosis below idiopathic intracranial hypertension, which fits her demographics better. Ordering purely by danger would have placed it first and driven immediate imaging for a patient whose examination is normal and whose pattern fluctuates. Neither extreme serves her. The compromise used here is stated so that a reader can disagree with it precisely: likelihood decides the order unless a candidate is both plausible from a specific finding in this case and capable of serious harm if missed, in which case it stays in the ranked list until a named step has addressed it. For this patient, that step is the contraceptive review and a clear instruction to return at once for any new neurologic symptom.
Defending the Leading Diagnosis
The leading diagnosis is frequent tension-type headache with coexisting episodic migraine, aggravated by rising analgesic use. The strongest evidence is internal to the history: two distinguishable headache types, one matching each disorder's features, and a frequency that rose in step with medication use. Detsky et al. (2006) found that the features she reported during the severe episodes, including nausea, pulsating quality, and disabling intensity, were among the most useful bedside predictors of migraine. A normal neurologic examination in a patient without red flags also lowers the probability of a significant intracranial finding.
The plan follows from the ranking. Analgesic use is capped at two to three days a week, with a headache diary to count headache days and medication days. Because estrogen-containing contraceptives are generally avoided in migraine with aura, and because the combination of a new contraceptive with a changed pattern keeps venous thrombosis on the list, the contraceptive is reviewed with her and a nonestrogen alternative discussed.
What Would Overturn This Conclusion
Three findings would move the leading diagnosis down. A headache that is progressive and present on waking, especially with vomiting, would raise concern for raised intracranial pressure. Any new visual symptom, focal neurologic sign, or seizure would move cerebral venous thrombosis to first place and require urgent imaging. Aura with the severe episodes would change the contraceptive decision from advisable to necessary. The candidate this paper found hardest to dismiss was cerebral venous thrombosis, because the only evidence against it is the absence of signs, and absent signs lower probability without excluding it.
References
Detsky, M. E., McDonald, D. R., Baerlocher, M. O., Tomlinson, G. A., McCrory, D. C., & Booth, C. M. (2006). Does this patient with headache have a migraine or need neuroimaging? JAMA, 296(10), 1274-1283. https://doi.org/10.1001/jama.296.10.1274
Do, T. P., Remmers, A., Schytz, H. W., Schankin, C., Nelson, S. E., Obermann, M., Hansen, J. M., Sinclair, A. J., Gantenbein, A. R., & Schoonman, G. G. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 92(3), 134-144. https://doi.org/10.1212/WNL.0000000000006697
Headache Classification Committee of the International Headache Society. (2018). The international classification of headache disorders, 3rd edition. Cephalalgia, 38(1), 1-211. https://doi.org/10.1177/0333102417738202
Perry, J. J., Stiell, I. G., Sivilotti, M. L. A., Bullard, M. J., Hohl, C. M., Sutherland, J., Emond, M., Worster, A., Lee, J. S., Mackey, D., Pauls, M., Lesiuk, H., Symington, C., & Wells, G. A. (2013). Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA, 310(12), 1248-1255. https://doi.org/10.1001/jama.2013.278018
What the NU 611 Unit 2 instructions ask for
The Unit 2 instructions ask you to develop a differential diagnosis for a presenting problem, usually from a case supplied in the classroom. Expect to list several plausible diagnoses with the findings that support and argue against each one. The differential must be ranked, and many sections want the ranking criteria stated, such as likelihood, severity or how treatable a condition is. You will usually defend one leading diagnosis with evidence and explain what further data would confirm it. Red flags or dangerous diagnoses should be addressed even when they are unlikely. Sources should include current clinical guidelines or diagnostic criteria and peer-reviewed studies on test accuracy where relevant. The paper follows APA 7 format, and the classroom rubric sets length and the number of diagnoses expected. Patient information should be composite, never drawn from a real person you have treated.
Inside the NU 611 Unit 2 example
The sample starts with a presentation section that describes two headache types in the same patient: a daily pressing headache worse after work and an occasional throbbing one with nausea and light sensitivity. Candidates are then introduced in the order they came to mind, each with a short list of supporting and opposing findings drawn from the history. A ranking section states its rule clearly, ordering by likelihood but placing a dangerous cause higher than its probability alone would justify. The defense of the leading diagnosis uses classification criteria to match each headache type and points to the rising analgesic use as an aggravating factor. Warning signs are checked against a published screening list. The final section names three findings, such as headache on waking with vomiting or a new visual symptom, that would move the leading diagnosis down and trigger imaging.
NU 611 Unit 2 rubric: what full points look like
Points in a Herzing differential diagnosis rubric typically go to the range of diagnoses, the supporting and refuting evidence, the ranking logic, the defense of the leading diagnosis and scholarly writing. The range criterion rewards a differential that includes both common causes and serious ones that must not be missed. Evidence points depend on tying specific history and exam findings to each candidate. Ranking is credited when the criteria are stated and applied consistently, rather than when diagnoses simply appear in a list. The defense of the leading diagnosis often carries the most weight and requires citations to diagnostic criteria or guidelines. Many rubrics also credit a plan for confirming or excluding diagnoses. Writing points go to clear organization, accurate terminology and correct APA references, with recent sources preferred for any test characteristic or guideline quoted.
NU 611 Unit 2 help before you submit
Many students lose points by listing five diagnoses with a sentence each and never explaining why one ranks above another. Others include only benign causes and leave out the serious possibilities a careful clinician must rule out. Evidence is often generic, such as "headache is common in migraine," instead of linked to this patient's specific features. A frequent weakness is naming the leading diagnosis without citing the criteria it meets. Some papers jump straight to imaging for every headache, which ignores decision rules and guideline advice on when scans help. Medication overuse is commonly forgotten even when the case mentions frequent analgesic use. Finally, a conclusion that admits what would change your mind is stronger than one that claims certainty, and many markers read for that kind of humility.
Get a NU 611 Unit 2 example written to your instructions
Give us the Unit 2 instructions and the rubric from your NU 611 classroom, plus the case and any required number of candidates. We write a custom example that ties each possibility to case findings, reasons every exclusion and defends the ranking, delivered inside 24 to 48 hours. The first custom sample is free.
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NU 611 Unit 2 questions, answered
How many diagnoses belong in the differential?
Your instructions may set a number, and where they do, meet it. Where the choice is yours, four to six argued properly beats ten named in passing, because each candidate needs supporting findings, opposing findings and a verdict to earn credit. A short list also leaves room for the dangerous possibilities, which are usually weighted more heavily than an extra common one.
Do I need a citation for every candidate?
For the clinical features you rely on, yes. When you claim a diagnosis typically presents in a particular way, that claim carries a source, ideally current clinical guidance rather than a general reference site. What does not need citing is your reasoning about this patient, since that is your own analysis. Rubrics in this course usually score evidence and reasoning as separate criteria.
What separates this from the reasoning paper earlier in NU 611?
The earlier work shows how possibilities were generated and how the thinking moved as information arrived. This one takes a set of candidates and argues them against each other to a ranked conclusion. One is a sequence, the other is a comparison. Submitting the same content for both usually loses criteria in each, because neither piece is doing the job its rubric describes.
Where can I find a free NU 611 Unit 2 sample paper?
The whole NU 611 Unit 2 differential is on this page without charge, including the candidate list, the ranking rule, the defense and the findings that would overturn it. If your case is a different complaint, send it through the request page and a custom differential written to your rubric arrives free in about two days.
How many diagnoses should a NU 611 differential include?
Most sections expect three to five, but the number matters less than the range: include the most likely causes and any dangerous condition that must be excluded. Give each one supporting and opposing findings, then rank them with a stated rule.