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Persistent Headache in a Young Woman


Headache and nausea have bothered this 28-year-old for 3 days. Over-the-counter analgesics do not help. She reports the headache lessens during the day. What more do you need to know?

A 28-year-old woman presents with a headache and nausea, which have been persistent over the past 3 days. She has taken acetaminophen without relief. The patient denies any history of migraines, trauma, fever, upper respiratory symptoms, vomiting, visual changes, or auras. She has been eating and sleeping well and denies stress or depression. She says that the headache seems to get much better during the day when she is at work.

 She has no significant past medical or surgical history. She takes only oral contraceptives and acetaminophen as needed for headaches, which typically are very infrequent. She admits to occasional tobacco and social alcohol use, but denies any other recreational drug use.

Medications: Oral contraceptives. Allergies: None. LMP: Currently

Vital signs: HR, 98 beats/min; oxygen saturation, 100% on room air

Physical including neurologicl exam is unremarkable.

1. What additional questions should be asked?

2. What diagnosis should be considered?

3. What tests, if any, should be performed?

Please leave your comments below, then click here for answer and discussion.

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