*EDIT At 8:00 PM. It sounds like this one is tricky. Upon further questioning, you learn that the halos around the lights did not precede the headache and are currently happening. Your preceptor rifles through some books and finds you a "classic" picture of this disease:
Challenge: Diagnosis?
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migraine headache?
Nausea and Vomiting
This is acute angle closure glaucoma, which can often mimic an acute abdomen. Narrowing or closure of the anterior chamber angle prevents adequate drainage of aqueous humor, leading to elevated intraocular pressure (>30mmHg when normal is 8-21 mmHg). Findings also include conjunctival redness, corneal edema or cloudiness, a shallow anterior chamber, and a mid-dilated pupil which reacts poorly to light. Treatment includes timolol, apraclonidine, and pilocarpine.
Sources: UpToDate; delhimedicalcouncil.nic.in, www.icoph.org.
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