CASE 48: HEADACHES
History
A 44-year-old woman presents to her general practitioner (GP) complaining of headaches.
These headaches have been present in previous years but have now become more intense.
She describes the headaches as severe and present on both sides of her head. They tend to
worsen during the course of the day. There is no associated visual disturbance or vomit-
ing. She also complains of loss of appetite and difficulty sleeping, with early morning wak-
ing. She has had eczema and irritable bowel syndrome diagnosed in the past but these
are not giving her problems at the moment. She is divorced with two children aged 10 and
12 years, whom she looks after. She has a part-time job as an office cleaner. Her mother
has recently died of a brain tumour. She smokes about 20 cigarettes per day and drinks 15
units of alcohol per week. She takes regular paracetamol or ibuprofen for her headaches.
Examination
She looks withdrawn. Her pulse is 74/min and regular, blood pressure is 118/76 mmHg.
Examination of the cardiovascular, respiratory and gastrointestinal systems, breasts and
reticuloendothelial system is normal. There are no abnormal neurological signs and fun-
duscopy is normal.
Questions
- What is the diagnosis?
- What are the major differential diagnoses?
- How would you manage this patient?