Author Affiliation: Dr Welch is Vice Chancellor for Research, University of Kansas School of Medicine, Kansas City.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR BURNS: Ms T is a 47-year-old divorced librarian
with a long history of headaches. She primarily receives treatment from Dr
D, an anesthesiologist and neurologist at Beth Israel Deaconess Medical Center.
She has managed care insurance.
Ms T had her first severe headache at 4 years of age, and she has had
headaches regularly (1-4 times per year) since the age of 15 years. Over the
years, her headaches became more frequent except for the 2 years when she
was pregnant and nursing her child. Ms T saw multiple neurologists and received,
at varying times, metoclopramide, prednisone, methysergide, amitriptyline,
low-dose verapamil, isometheptene/dichloralphenazone/acetaminophen (Midrin),
propranolol, ergotamine/belladonna/phenobarbital (Bellergal-S), diazepam,
sumatriptan, aspirin/butalbital/caffeine (Fiorinal), pseudoephedrine, and
dihydroergotamine. Her past medical history was otherwise unremarkable except
for sinus problems and depression prominent particularly during her menses.
She had normal findings on a magnetic resonance imaging (MRI) scan of the
head. Family history is notable for a brother who died of a brain tumor.
Welch KMA. A 47-Year-Old Woman With Tension-type Headaches. JAMA. 2001;286(8):960-966. doi:10.1001/jama.286.8.960