| Course | NUR 560 Advanced Health Assessment and Clinical Reasoning |
|---|---|
| Module | Module 3 |
| Paper type | Assessment and reasoning write-up (milestone) |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 560 Module 3
Milestone One: Throbbing Headaches in a 34-Year-Old, Red Flags, Migraine Criteria and the Pill That Mattered Most
[Student Name]
Southern New Hampshire University
NUR 560: Advanced Health Assessment and Clinical Reasoning
Milestone One
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone One: Throbbing Headaches in a 34-Year-Old, Red Flags, Migraine Criteria and the Pill That Mattered Most
Most headaches seen in primary care are primary headaches, migraine and tension-type, and the reasoning task is to recognize them confidently while screening for the uncommon secondary causes that must not be missed. This milestone documents the assessment of a composite 34-year-old woman with worsening headaches. It argues that her history fits migraine with aura, that a systematic screen for red flags finds only one, a change in pattern, which is explained by increased analgesic use and stress rather than by a dangerous cause, and that the most important decision is not imaging but stopping her estrogen-containing pill.
History and Examination
For eight years she has had one-sided throbbing headaches with nausea and sensitivity to light and noise, lasting 8 to 24 hours and made worse by climbing stairs. About twenty minutes before many attacks she sees a shimmering zigzag line that spreads across her vision and fades. Attacks used to occur twice a month; over the past three months they have come weekly during a stressful job change, and she now takes ibuprofen on about twelve days a month. She has used a combined oral contraceptive containing ethinyl estradiol for four years. She denies sudden severe onset, fever, weight loss, weakness, numbness, speech change, headaches worse lying down or with coughing, and any head injury.
Examination is normal. Blood pressure is 118/74 mm Hg and body mass index 24. Fundoscopy shows sharp optic disc margins without swelling. Cranial nerves, strength, sensation, coordination, reflexes and gait are normal.
Screening for Red Flags
The SNNOOP10 list gathers the red and orange flags that raise the likelihood of a secondary headache, including systemic symptoms, neoplasm history, neurologic deficits, sudden onset, onset after 65, a change in pattern, positional features, precipitation by coughing or exertion, papilledema, progression, pregnancy, eye pain with autonomic features, trauma, immune compromise and painkiller overuse or a new drug (Do et al., 2019). Checked item by item, she has no systemic symptoms, deficits, papilledema or positional features, and her onset was neither sudden nor late in life. Two items apply: a change in pattern, with attacks becoming more frequent, and analgesic use on about twelve days a month, approaching the threshold for medication overuse. Both have a plausible explanation that does not point to structural disease, but both need to be addressed.
Checking Migraine Criteria
The International Classification of Headache Disorders defines migraine without aura by attacks lasting 4 to 72 hours with at least two of unilateral location, pulsating quality, moderate or severe intensity and aggravation by routine activity, plus nausea or light and sound sensitivity; migraine with aura adds fully reversible visual or other neurological symptoms that spread gradually and last 5 to 60 minutes (Headache Classification Committee of the International Headache Society, 2018). Her attacks meet every element: 8 to 24 hours, one-sided, throbbing, worse with stairs, with nausea and photophobia, and a spreading zigzag aura of about twenty minutes. The diagnosis is migraine with aura.
Problem Representation and Ranked Differential
Problem representation: a 34-year-old woman with long-standing, recurrent, unilateral throbbing headaches with visual aura, now more frequent, with frequent analgesic use, estrogen exposure and a normal neurological examination.
1. Migraine with aura, worsening in frequency. For: criteria fully met, eight-year history, normal examination. Against: none significant.
2. Medication overuse headache developing on top of migraine. For: ibuprofen on about twelve days a month. Against: below the usual threshold of 15 days for simple analgesics, but close enough to watch.
3. Cerebral venous thrombosis, dangerous and considered. For: estrogen exposure. Against: no progressive or positional headache, no papilledema, no deficits, long stable history.
4. Idiopathic intracranial hypertension. For: young woman. Against: normal body mass index, no positional or pulsatile features, sharp disc margins.
5. Subarachnoid hemorrhage or other structural cause. Against: no sudden onset, no deficits, no red flags pointing to a mass. Imaging is not indicated on current findings.
The Finding That Changes Management
The most important finding is her combined estrogen pill. Migraine with aura is associated with an increased risk of ischemic stroke, and estrogen adds to it. The 2024 federal contraceptive eligibility criteria classify combined hormonal contraception as an unacceptable health risk, category 4, for people with migraine with aura (Nguyen et al., 2024). Her contraceptive should therefore be changed to a method without estrogen, such as a progestin-only method or an intrauterine device, chosen with her. This decision matters more for her safety than any test.
Why Not Scan Her Anyway
She asked for a brain scan, and it would be easy to order one to reassure her. The reasoning above argues against it. Her headaches meet the criteria for a primary disorder, her examination is normal and the only red flags have benign explanations; in that situation imaging is unlikely to find a cause and more likely to find incidental findings that lead to further tests and anxiety. Explaining this is part of the plan. She is told what the history and examination have shown, why migraine explains her symptoms and exactly which changes would prompt a scan, which gives her a clear threshold rather than a vague reassurance. Addressing the request directly, rather than ignoring it, also builds the trust she will need to accept the more important change to her contraception.
Plan and What Would Change It
The plan is to change contraception; limit ibuprofen to no more than two or three days a week and add a triptan for moderate to severe attacks if there is no vascular contraindication; start a headache diary; discuss preventive treatment, since weekly attacks meet the usual threshold for considering it; and address sleep and stress during her job change. She is told to seek care at once for a sudden severe headache, a headache with weakness or confusion, a headache that is worse lying down or an aura lasting more than an hour. Any of these, new papilledema, or a headache that becomes progressive would move a secondary cause up the list and call for urgent imaging.
Conclusion
Her headaches meet the criteria for migraine with aura, and a systematic red flag screen finds only a change in pattern and frequent analgesic use, both explained without a dangerous cause. The ranked differential keeps cerebral venous thrombosis and idiopathic intracranial hypertension in view and explains why they are unlikely. The decisive step is changing her estrogen-containing contraceptive, which national criteria advise against with migraine with aura. Milestone Two will extend this approach to a presentation where the dangerous diagnosis is harder to exclude.
References
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
Nguyen, A. T., Curtis, K. M., Tepper, N. K., Kortsmit, K., Brittain, A. W., Snyder, E. M., Cohen, M. A., Zapata, L. B., & Whiteman, M. K. (2024). U.S. medical eligibility criteria for contraceptive use, 2024. MMWR Recommendations and Reports, 73(4), 1-126. https://doi.org/10.15585/mmwr.rr7304a1
What the NUR 560 Module 3 instructions ask for
Milestone One in NUR 560 usually asks for a complete assessment and reasoning write-up for a single presentation: focused history and examination, a problem representation, a ranked differential with supporting and opposing findings, and a plan. Some sections require a specific format such as SOAP; others ask for a narrative. For headache, prompts often expect a systematic red flag screen and the use of recognized diagnostic criteria. Milestones typically run four to six pages in APA 7. Review the patient's full medication list as part of the reasoning, because a drug can be a cause, a risk or a contraindication, and in some cases it changes the plan more than any diagnostic test.
How this NUR 560 Module 3 milestone one example is built
The sample assesses a composite 34-year-old woman with worsening one-sided throbbing headaches and visual aura. It screens her against the SNNOOP10 red flags item by item, finding a pattern change and frequent analgesic use, and checks her attacks against the International Classification of Headache Disorders criteria for migraine with aura. A problem representation and a five-item ranked differential follow, each diagnosis argued with findings. The key management point is her combined estrogen pill, classified as an unacceptable risk with migraine with aura in the 2024 U.S. contraceptive criteria. A plan with warning signs and triggers for imaging closes the milestone, supported by three real sources. The patient's request for a scan is addressed with the reasoning behind the decision.
Where the NUR 560 Module 3 rubric puts the points
Reasoning milestones are generally graded on focused data gathering, systematic screening for dangerous causes, correct use of diagnostic criteria, the problem representation, a ranked and argued differential, a plan grounded in evidence and documentation. Red flag screening earns credit when it is systematic and when positive items are interpreted, not ignored. Diagnostic criteria should be applied element by element. The differential must include dangerous possibilities with reasons they are more or less likely. Graders also value attention to the whole patient, such as a medication risk, and a clear statement of what would prompt escalation or imaging. Explaining a decision not to test, with clear triggers for testing later, earns credit for judgment.
NUR 560 Module 3 help: the mistakes that cost points
Headache write-ups often lose points by ordering imaging for every headache, by listing red flags without applying them to the patient or by diagnosing migraine on impression without the criteria. Others overlook a medication interaction or contraindication hiding in the history. Screen red flags item by item, apply the diagnostic criteria, write a problem representation, rank and argue the differential, review every medicine and end with warning signs and what would change the plan. Keep the reasoning visible on the page. A different milestone case can have its own assessment and reasoning write-up built from the details you share. If the patient asks for a test you do not recommend, explain your reasoning and give clear thresholds.
Get NUR 560 Module 3 written to your instructions
Provide the case details, your milestone brief and its grading criteria. An assessment and reasoning write-up with a systematic red flag screen, applied criteria, a ranked differential and a plan is ready in 24 to 48 hours, and the first one is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 560 Module 3 questions, answered
Where can I find a free NUR 560 Module 3 Milestone One sample?
The complete milestone on this page is free to read: headache in a composite 34-year-old with the SNNOOP10 red flag screen, migraine criteria, a ranked differential and a contraceptive risk that changes management.
What is the SNNOOP10 list?
A checklist of red and orange flags, such as sudden onset, neurologic deficits, papilledema and pattern change, that raise the likelihood of a secondary headache.
What defines migraine with aura?
Recurrent attacks with fully reversible visual or other neurological symptoms that spread gradually and usually last 5 to 60 minutes, often followed by migraine headache.
Why is estrogen contraception avoided with migraine with aura?
Both increase the risk of ischemic stroke, and U.S. criteria classify combined hormonal contraception as an unacceptable risk, category 4, for people with migraine with aura.
When does a headache need imaging?
When red flags suggest a secondary cause, such as sudden severe onset, neurologic deficits, papilledema, progressive or positional pain.