The Case Files: Unusual Headache

By Al-Hashimi, Siddhartha DO; Leavens, John MD A 23-year-old woman with a history of migraine headaches presented to the emergency department for a different-than-usual headache. She had a six-day history of intermittent headaches. The onset was at rest, and there was no history of trauma.   The headache was located behind her left eye, and it radiated into the posterior portion of her head. She characterized it as being 8/10 in intensity. Bright lights were reported as an exacerbating factor. The headache was associated with nausea and multiple episodes of emesis. She had 10 episodes of vomiting the evening prior to arrival, which prompted her to seek ED evaluation. She had viral meningitis at age 16, and ever since had been experiencing infrequent ocular migraine headaches. Her headaches had never previously been associated with nausea or vomiting. Review of systems was otherwise negative.   The patient reported using an etonogestrel/ethinyl estradiol vaginal ring for contraception, and denied any other prescription medication use. Social history was negative for nicotine, alcohol, and illicit drug use. The patient's vital signs were normal. Physical exam revealed a well-nourished young woman who appeared uncomfortable. The patient's head was atraumatic, and there were no meningismus or focal neurological signs. The physical exam was otherwise unremarkable.   An unenhanced CT of the brain revealed a denser-than-usual distal straight sinus. Subsequent MRI and intracranial...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research