Bebe Babbitt iHuman Case Study
Bebe Babbitt is a 27-year-old female presenting with a history of frequent headaches over the past several months. The headaches have progressively worsened in frequency and duration, often accompanied by nausea, vomiting, blurred vision, and sensitivity to light and sound. Notably, relief only comes with sleep. She reports seeing “flashing zig-zaggy lights” prior to headaches, denies changes in orientation, memory. Denies dizziness, weakness, numbness, tingling, seizures.
In this comprehensive guide, we’ll walk you through how to approach her case, from initial neurological assessment through systematic physical examination to the final diagnosis of Migraine with Aura. You’ll learn the key clinical reasoning steps for headache disorders, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this essential primary care case simulation involving migraine diagnosis and management.
Bebe Babbitt iHuman Case Overview (Doorway Information)
Patient Overview: Bebe Babbitt, a fictional patient, presents with a chief complaint of recurrent severe headaches. She describes a pattern of episodic migraines, lasting several hours to days and significantly impacting her daily life. Bebe reports experiencing nausea, photophobia, and phonophobia during migraine attacks. Additionally, she mentions a family history of migraines, suggesting a potential genetic predisposition to the condition.
Key Background Information:
- Age/Gender: 22-27-year-old female (varies by version)
- Height/Weight: 122 lbs, BMI 19
- Occupation: Graduate student and waitress
- Chief Complaint: Worsening episodic headaches with associated symptoms
- Presenting Situation: Psychology grad student who presents with worsening episodic headaches, now occurring every 1-2 weeks over the past few months, compared to prior frequency of every 1-2 months for the past 10 years
- Associated Conditions: Stress from graduate school and her job as a waitress
- Significant History: Family history of migraines
- Current Status: Previously undiagnosed migraine disorder requiring intervention
- Risk Factors: Female gender, stress, family history, young adult age
- Physical Findings: Normal neurological examination, no depression, anxiety or cognitive impairment noted
The patient appears well but has been experiencing increasing frequency and severity of headaches that significantly impact her daily functioning. Her presentation with classic migraine symptoms including aura, photophobia, phonophobia, and associated gastrointestinal symptoms suggests primary migraine headache disorder requiring comprehensive evaluation and management.
Bebe Babbitt (22-27 y/o female) – Adult Neurological Assessment
- CC: Worsening episodic headaches with associated symptoms
- MSAP: Migraine with Aura – requiring acute and preventive therapy
- Associated symptoms: Nausea, vomiting, blurred vision, and sensitivity to light and sound
- History: Seeing “flashing zig-zaggy lights” prior to headaches, stress-related triggers
- High-risk factors: Female gender, family history, stress, young adult age
History Questions
- How can I help you today?
- What brought you to the clinic today?
- Tell me about these headaches you’ve been having?
- When did you first start having headaches?
- Have you noticed any patterns or triggers that seem to bring on the headaches? (e.g., stress, lack of sleep, specific foods)
- How often do you get these headaches now compared to before?
- How long do the headaches typically last?
- Where exactly do you feel the pain in your head?
- Can you describe what the headache feels like?
- Do you have any warning signs before the headache starts?
- Do you see any visual changes before or during the headaches?
- Do you experience nausea or vomiting with the headaches?
- Are you sensitive to light or sound during episodes?
- What helps relieve your headaches?
- Have you tried any medications for the headaches?
- Do you have any family history of headaches or migraines?
- What is your occupation? Does your job involve stress, heavy physical activity, or prolonged screen time?
- How do these headaches affect your daily activities?
- Do you have any other medical problems?
- Are you taking any medications regularly?
- Do you have any allergies?
Physical Exam
Vitals: Blood pressure, pulse, respirations, temperature, weight, height, BMI calculation
General appearance: Appearance appropriate for age and setting. Mood stable and affect appropriate
Neurological Assessment:
- Mental Status: Thought process logical. No depression, anxiety or cognitive impairment noted
- Cranial Nerves: Complete cranial nerve examination including visual fields, pupillary responses, extraocular movements
- Motor Function: Rapid alternating movements smooth, quick and coordinated bilaterally
- Sensory Function: Symmetric sensitivity bilaterally in all extremities, face, thorax and back
- Reflexes: Reflexes intact
- Coordination and Gait: Assessment of balance, coordination, and gait stability
Head, Eyes, Ears, Nose, Throat (HEENT):
- Detailed examination for signs of increased intracranial pressure
- Fundoscopic examination to rule out papilledema
- Temporal artery palpation and assessment
- Neck examination for meningeal signs
Cardiovascular Assessment:
- Heart rate and rhythm evaluation
- Blood pressure assessment
- Assessment for signs of hypertensive emergency
Additional Systems Review:
- Respiratory: Basic assessment to rule out systemic illness
- Lymphatic: Cervical, axillary, epitrochlear, and inguinal lymph node mobile, non-tender, pea-sized and soft bilaterally
- Integumentary: Skin warm and dry with no lesion seen, good skin turgor
Assessment Note
B.B. is a 27-year-old female presenting with worsening episodic headaches with classic migraine features including visual aura, photophobia, phonophobia, and associated gastrointestinal symptoms. Physical examination notable for normal neurological findings without focal deficits or signs of increased intracranial pressure. Her presentation with typical migraine characteristics, family history, and stress-related triggers indicates primary migraine headache disorder requiring comprehensive acute and preventive management.
Diagnostic Testing: Neuroimaging (MRI or CT) if indicated by red flags, complete metabolic panel, thyroid function tests, vitamin B12 and magnesium levels
Diagnosis: Migraine with Aura
Plan:
- Initiate acute migraine therapy with triptans
- Lifestyle modification counseling for trigger avoidance
- Stress management strategies and behavioral therapy referral
- Consider preventive therapy if frequency increases
- Patient education about migraine management
- Regular follow-up care and headache diary implementation
Bebe Babbitt SOAP Note
Patient: Bebe Babbitt
Subjective Data
CC: Frequent, worsening headaches over the past few months with associated nausea, vomiting, and sensitivity to light and sound
HPI: 22-26 years old female psychology grad student who presents with worsening episodic headaches, now occurring every 1-2 weeks over the past few months, compared to prior frequency of every 1-2 months for the past 10 years. Patient reports severe, throbbing headaches that significantly impact her daily functioning and academic performance. Reports seeing “flashing zig-zaggy lights” prior to headaches, followed by unilateral or bilateral head pain accompanied by nausea, vomiting, photophobia, and phonophobia. Relief only comes with sleep. Patient identifies stress from graduate school and work as potential triggers.
Medications: Over-the-counter pain relievers as needed (specific medications vary by case version)
Allergies: No known drug, food, or environmental allergies reported
PMH: Reports feeling stressed and mildly anxious with school and work. Stress triggers the headaches, no previous neurological diagnoses, no history of head trauma or significant medical conditions
Family History: Family history of migraines, suggesting a potential genetic predisposition to the condition
Social History: Graduate psychology student working part-time as waitress, high stress levels from academic and work demands, denies tobacco or illicit drug use, occasional social alcohol consumption
Review of Systems: Reports seeing “flashing zig-zaggy lights” prior to headaches, denies changes in orientation, memory. Denies dizziness, weakness, numbness, tingling, seizures. Notable for stress-related triggers and significant functional impairment during episodes.
Objective Data
General: Alert, oriented female in no acute distress, appears stated age
Vital Signs: Blood pressure, heart rate, respiratory rate, and temperature within normal limits; BMI 19 (normal weight)
Physical Examination:
- Appearance: Appearance appropriate for age and setting. Mood stable and affect appropriate
- Neurological: Symmetric sensitivity bilaterally in all extremities, face, thorax and back. Rapid alternating movements smooth, quick and coordinated bilaterally. Reflexes intact
- HEENT: Normal fundoscopic examination without papilledema, normal temporal artery examination
- Neck: No nuchal rigidity, no lymphadenopathy
- Cardiovascular: Regular rate and rhythm, no murmurs
- Other Systems: Skin warm and dry with no lesion seen, good skin turgor, lymphatic: cervical, axillary, epitrochlear, and inguinal lymph node mobile, non-tender, pea-sized and soft bilaterally
Assessment
Primary Diagnosis: Migraine with Aura (G43.109)
Secondary Concerns:
- Stress-related headache triggers
- Academic and occupational functional impairment
- Need for lifestyle modification and stress management
Differential Diagnoses
Migraine with Aura: Most likely diagnosis given the patient’s presentation with visual aura (“flashing zig-zaggy lights”), unilateral or bilateral throbbing headache, photophobia, phonophobia, nausea, and vomiting. Family history of migraines, suggesting a potential genetic predisposition further supports this diagnosis. The episodic nature and stress-related triggers are characteristic of primary migraine.
Tension-Type Headache: Tension headaches are less harmful as they do not necessarily interrupt the daily activities, does not affect vision, breathing or blood pressure. Less likely given the severity of symptoms, presence of visual aura, and associated gastrointestinal symptoms that are not typical of tension headaches.
Cluster Headache: Less likely given the patient’s demographics (more common in males), duration of episodes (cluster headaches are typically shorter), and pattern of occurrence. The presence of visual aura also makes cluster headache less probable.
Secondary Headache (Brain Tumor, Increased ICP): Important to rule out but less likely given the chronic episodic pattern, normal neurological examination, and absence of progressive neurological symptoms or signs of increased intracranial pressure.
Medication Overuse Headache: Possible consideration if patient is frequently using over-the-counter medications, but the long-standing history and episodic pattern suggest primary migraine disorder.
Most Likely Diagnosis: Migraine with Aura evidenced by characteristic visual aura, severe episodic headaches with classic associated symptoms, family history, and stress-related triggers in appropriate demographic population.
Plan
Health Promotion: ✓ Lifestyle Modifications – Comprehensive trigger identification and avoidance, stress management techniques, regular sleep schedule maintenance ✓ Dietary Counseling – Identification and avoidance of dietary triggers, regular meal patterns, adequate hydration ✓ Exercise Prescription – Regular moderate exercise program while avoiding exercise during acute episodes ✓ Patient Education – Understanding of migraine disorder, trigger recognition, appropriate medication use, headache diary maintenance
Screening: ✓ Neurological Assessment – Consider neuroimaging if red flags present or atypical features develop ✓ Laboratory Studies – Basic metabolic panel, thyroid function tests, vitamin B12 and magnesium levels if indicated ✓ Headache Diary – Implementation of detailed headache tracking for pattern recognition and treatment monitoring
Interventions: ✓ Acute Migraine Therapy – Sumatriptan as first-line treatment, use at first sign of migraine ✓ Antiemetic Therapy – Metoclopramide for associated nausea and vomiting ✓ Preventive Therapy – Consider if headache frequency increases or significantly impacts quality of life ✓ Behavioral Interventions – Behavioral health counseling referral for cognitive behavioral therapy to reduce stress and anxiety
Long-term Management: ✓ Follow-up Plan – Return visit in 4-6 weeks to assess treatment response and medication tolerance ✓ Monitoring – Limit sumatriptan use to an average two headache days per week and 10 days per month ✓ Specialist Referral – Referral to neurologist or headache specialist not needed at this visit. Referral to specialist should be done if patient fails initial treatment
Complete Step-by-Step Guide to Writing the Bebe Babbitt iHuman Case Study
Completing the Bebe Babbitt iHuman case requires a systematic approach focused on adult neurological assessment and evidence-based migraine management. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.
Step 1: Pre-Case Preparation and Initial Approach
Before diving into the case, review the doorway information and formulate your initial clinical approach.
Key Information to Note:
- Young adult female with worsening episodic headaches
- Classic migraine symptoms including visual aura
- Stress-related triggers from academic and work demands
- Family history of migraines
Initial Clinical Mindset: Approach this case with primary migraine headache as your leading consideration. The combination of visual aura, episodic pattern, and family history strongly suggests migraine disorder, which affects approximately 12% of adults and is three times more common in women.
Step 2: Conducting the History of Present Illness (HPI)
The HPI is crucial for establishing the foundation of your headache diagnosis. Use the OLDCARTS mnemonic systematically:
Onset: Ask about when headaches first began and recent changes in pattern
- Key points to elicit: Long-standing history, recent worsening in frequency
- Target response: Headaches for past 10 years, now occurring every 1-2 weeks versus previous 1-2 months
Location: Determine specific areas of head pain
- Important detail: Unilateral versus bilateral, specific regions affected
- Critical descriptors: Throbbing, pulsating quality typical of migraine
Duration: How long each episode lasts
- Essential findings: Lasting several hours to days and significantly impacting her daily life
Character: Detailed description of pain quality and associated symptoms
- Critical descriptors: Visual aura with “flashing zig-zaggy lights,” nausea, vomiting, photophobia, phonophobia
Aggravating factors: What makes headaches worse
- Essential findings: Stress from graduate school and her job as a waitress
Relieving factors: What provides relief
- Key response: Relief only comes with sleep
Timing: Pattern of headache occurrence
- Important pattern: Episodic nature, increasing frequency, relationship to stress
Severity: Impact on daily function and quality of life
- Typical response: Significant functional impairment, inability to perform academic or work duties
Step 3: Review of Systems (ROS)
Conduct a thorough but focused ROS, paying special attention to neurological and related systems:
Neurological:
- Visual changes, aura phenomena, focal neurological symptoms
- Cognitive changes, memory problems, mood changes
- Seizure activity, loss of consciousness
Constitutional:
- Fever, weight changes, fatigue patterns
- Sleep quality and patterns
Gastrointestinal:
- Nausea, vomiting, dietary triggers
- Changes in appetite or eating patterns
Psychiatric:
- Stress levels, anxiety, depression
- Coping mechanisms and support systems
Step 4: Past Medical History, Social History, and Family History
Past Medical History:
- Previous headache diagnoses or treatments
- Neurological conditions, head trauma
- Hormonal factors (menstrual relationship)
- Medication history and responses
Social History:
- Graduate student and waitress – assess stress levels
- Lifestyle factors, sleep patterns, dietary habits
- Substance use (alcohol, tobacco, caffeine)
- Support systems and coping mechanisms
Family History:
- Family history of migraines, suggesting a potential genetic predisposition
- Other neurological conditions in family
- Cardiovascular disease, psychiatric conditions
Step 5: Physical Examination Strategy
Perform a comprehensive neurological physical examination:
General Assessment:
- Expected findings: Alert, oriented female in no acute distress
- Critical component: Overall neurological and mental status assessment
Vital Signs:
- Look for: Normal vital signs, appropriate BMI
Neurological Examination:
- Mental Status: Thought process logical. No depression, anxiety or cognitive impairment noted
- Motor Function: Rapid alternating movements smooth, quick and coordinated bilaterally
- Sensory Function: Symmetric sensitivity bilaterally in all extremities, face, thorax and back
- Reflexes: Reflexes intact
Head and Neck Examination:
- Detailed assessment for signs of increased intracranial pressure
- Fundoscopic examination to rule out papilledema
- Temporal artery and neck assessment
Step 6: Developing Differential Diagnoses
Propose at least 4-5 appropriate differentials with rationales:
Primary Consideration: Migraine with Aura
- Supporting evidence: Visual aura, episodic pattern, family history, stress triggers
Secondary Considerations:
- Tension-type headache: Less likely given severity and aura
- Cluster headache: Demographics and pattern don’t fit
- Secondary headache: Rule out with appropriate workup
- Medication overuse headache: Consider if frequent analgesic use
Step 7: Diagnostic Test Interpretation
Interpret clinical findings to support your diagnosis:
Expected Key Findings:
- Normal neurological examination
- Normal vital signs and general appearance
- Absence of red flags for secondary headache
- Classic migraine symptom pattern
Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)
Primary Diagnosis: Migraine with Aura
Justification:
- Visual aura with “flashing zig-zaggy lights”
- Classic associated symptoms (nausea, photophobia, phonophobia)
- Family history of migraines
- Episodic pattern with stress-related triggers
MSAP Selection: Choose “Migraine with Aura” as your Most Significant Active Problem, as this represents the primary neurological condition requiring immediate and long-term management.
Step 9: Comprehensive Management Plan
Develop a multi-faceted treatment approach:
Immediate Management:
- Acute migraine therapy with sumatriptan
- Antiemetic therapy with metoclopramide
- Patient education about proper medication use
Short-term Management:
- Medication regimen: Sumatriptan at first sign of migraine, limit use to average two headache days per week
- Lifestyle counseling: Stress management, trigger identification and avoidance
- Behavioral interventions: Cognitive behavioral therapy referral
Long-term Management:
- Regular follow-up every 4-6 weeks initially
- Consider preventive therapy if frequency increases
- Headache diary implementation for pattern tracking
- Specialist referral if initial treatment fails
Patient Education:
- Understanding migraine as chronic disorder that cannot be cured but is manageable
- Proper sumatriptan use and avoiding overuse to prevent rebound headaches
- Trigger avoidance strategies including dietary, stress, and sleep pattern management
Step 10: Documentation and Submission Tips
Writing Your Summary:
- Create a concise 350-word summary explaining your clinical reasoning for migraine diagnosis
- Include how you arrived at the problem list with consideration of neurological assessment
- Cite specific examination findings and symptom patterns
- Use professional neurological terminology
Key Documentation Elements:
- Assessment Statement: Brief patient summary with key neurological findings
- Clinical Reasoning: Explain diagnostic thought process for migraine with aura
- Evidence-Based Management: Link treatment choices to current headache guidelines
- Risk Stratification: Address trigger management and prevention strategies
Final Submission Checklist:
- ✓ Complete neurological history with systematic headache assessment
- ✓ Comprehensive physical examination including detailed neurological assessment
- ✓ Appropriate differential diagnoses with headache considerations
- ✓ Correct final diagnosis and MSAP
- ✓ Evidence-based migraine management plan
- ✓ Professional documentation with proper neurological terminology
Bebe Babbitt iHuman Case Summary Grading Criteria
The Bebe Babbitt iHuman case will evaluate you across several critical domains to ensure comprehensive neurological assessment skills. Here’s what you need to focus on to maximize your score:
(1) History Taking (Major Points): You must ask targeted questions about headache characteristics, associated symptoms, and family history to get full credit. Essential questions include: headache pattern and frequency, visual aura and associated symptoms, family history of migraines, stress and trigger identification, functional impact assessment. Don’t miss asking about: medication use and effectiveness, sleep patterns, dietary factors, menstrual relationship (if applicable), previous treatments attempted. The rubric specifically rewards students who ask about migraine-specific symptoms and comprehensive trigger assessment.
(2) Physical Examination (High Weight): Focus your exam on systematic neurological assessment and headache-related findings. Must-do components: complete neurological examination, mental status assessment, fundoscopic examination, assessment for meningeal signs, cranial nerve examination. Pro tip: The rubric awards points for thorough neurological characterization and systematic assessment – key components that relate directly to headache diagnosis and ruling out secondary causes.
(3) Differential Diagnosis (Critical for Scoring): You need to propose at least 4 appropriate differentials with brief rationales. Expected differentials include: Migraine with Aura, Tension-Type Headache, Cluster Headache, and Secondary Headache disorders. Scoring secret: The rubric rewards students who can distinguish between primary and secondary headache disorders based on clinical presentation, symptom patterns, and physical examination findings.
(4) Final Diagnosis & MSAP: You must correctly identify Migraine with Aura as your Most Significant Active Problem (MSAP). Justification is key – cite the visual aura, episodic pattern, family history, and classic associated symptoms as supporting evidence.
(5) Management Plan (Heavily Weighted): The rubric expects comprehensive migraine management including: appropriate acute therapy selection, trigger identification and avoidance, lifestyle modification counseling, and long-term follow-up planning. High-scoring responses mention: sumatriptan therapy with proper usage guidelines, behavioral therapy referral, headache diary implementation, and preventive strategy discussion.
(6) Patient Communication: Demonstrate appropriate communication for young adults with neurological conditions. Bonus points for: explaining migraine in patient-friendly terms, discussing trigger management strategies, addressing lifestyle modifications, and providing clear medication instructions.
Example of a High-Scoring Clinical Summary
Here’s how a top-performing student might document this case:
Patient Summary – Bebe Babbitt
Situation: 27-year-old female presenting with worsening episodic headaches with classic migraine features requiring comprehensive acute and preventive management strategies.
Background: Significant findings include appropriate demographic risk factors, family history of migraines, and stress-related triggers from graduate school and work demands. Physical examination notable for normal neurological findings without focal deficits.
Assessment: Physical examination notable for alert, oriented female with visual aura (“flashing zig-zaggy lights”) preceding severe episodic headaches accompanied by nausea, vomiting, photophobia, and phonophobia. Clinical presentation and examination findings strongly support primary migraine with aura diagnosis.
Primary Diagnosis: Migraine with Aura
Recommendation:
- Initiate acute migraine therapy with sumatriptan at first sign of symptoms
- Antiemetic therapy with metoclopramide for associated nausea and vomiting
- Comprehensive lifestyle modifications including stress management and trigger avoidance
- Behavioral health counseling referral for cognitive behavioral therapy
- Headache diary implementation for pattern tracking and treatment monitoring
- Follow-up in 4-6 weeks for treatment response assessment
Patient and Family Education Provided: Explained migraine as chronic disorder that cannot be cured but is manageable with proper pharmacological and non-pharmacological interventions, discussed proper medication use and overuse prevention, emphasized trigger identification and avoidance strategies, provided stress management techniques, and established clear follow-up plan with return precautions for concerning symptoms.
Conclusion
By following this comprehensive approach to the Bebe Babbitt case, you’ll demonstrate the neurological assessment skills that iHuman evaluates. Remember, success in headache cases requires understanding primary versus secondary headache differentiation: gather detailed history about headache characteristics and triggers, perform systematic neurological examination, consider age-appropriate headache diagnoses in differential diagnosis, and develop evidence-based migraine management plans with both acute and preventive strategies. The key is treating each iHuman simulation as you would a real neurological encounter – be thorough, consider the complexity of headache diagnosis and management, and always prioritize evidence-based therapy and comprehensive patient education. With this guide, you’re well-prepared to excel in this essential primary care neurological case simulation.
Frequently Asked Questions
Q1: What is the correct diagnosis for Bebe Babbitt’s presentation?
Bebe Babbitt’s primary diagnosis is Migraine with Aura. The key distinguishing features include visual aura with “flashing zig-zaggy lights,” severe episodic headaches with classic associated symptoms including nausea, vomiting, photophobia, and phonophobia, along with family history of migraines. Students often struggle between migraine and tension-type headache, but remember that the presence of visual aura and severe associated symptoms are characteristic of migraine disorder.
Q2: What are the critical physical examination components I need to perform to score well?
Essential physical exam elements include comprehensive neurological examination with attention to mental status, cranial nerves, motor and sensory function, reflexes, and coordination. Key findings include normal neurological examination with intact reflexes, symmetric sensitivity, and coordinated movements. Many students miss points by inadequately assessing for signs of increased intracranial pressure or failing to perform thorough fundoscopic examination, which are crucial for ruling out secondary headache causes.
Q3: How do I pass the Bebe Babbitt case and meet the 70% requirement?
You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough headache history-taking using systematic questioning about migraine-specific symptoms, complete all recommended neurological exam components, propose appropriate differential diagnoses (including Migraine with Aura, Tension-Type Headache, and Secondary Headache disorders), and develop a comprehensive evidence-based management plan that includes acute therapy with sumatriptan, lifestyle modifications, behavioral interventions, and proper follow-up strategies. The key is being systematic and remembering that headache cases require evidence-based neurological management principles.
Q4: What management interventions should I include in my treatment plan?
The comprehensive management plan should focus on evidence-based migraine therapy with sumatriptan as first-line acute treatment used at first sign of symptoms and antiemetic therapy with metoclopramide for associated nausea and vomiting. Include comprehensive lifestyle modifications with trigger identification and avoidance, stress management strategies, and behavioral health counseling referral for cognitive behavioral therapy. Students often forget to address proper medication usage guidelines, headache diary implementation, and medication overuse prevention, which are crucial components for managing migraine disorders and can significantly impact your overall score.