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July 23, 1997

A 27-Year-Old Woman With Migraine Headaches

Author Affiliations

Dr Welch is Director, Headache and NMR Research Centers, Department of Neurology, Henry Ford Hospital and Health Sciences Center. Detroit, Mich; Professor of Neurology. Case Western Reserve University, Cleveland, Ohio; Clinical Professor of Neurology, University of Michigan, Ann Arbor; and Adjunct Professor of Physics, Oakland University, Rochester, Mich.
Dr Welch is a consultant for Glaxo/Wellcome and has received honoraria from Zeneca Corp.

JAMA. 1997;278(4):322-328. doi:10.1001/jama.1997.03550040078041

Dr Daley:  Mrs D is a 27-year-old married elementary school teacher with migraine headaches. She recently moved to Boston from the Midwest and works as a substitute teacher. Her health care insurance is through a commercial managed care plan. Her doctor, Dr N, practices in the primary care unit at Beth Israel Deaconess Medical Center.Mrs D has been in good health aside from migraine headaches since the age of 10 years. Her mother, brother, and a maternal aunt also have migraines. She has had "normal" computed tomographic scans and electroencephalograms. Her headaches begin with a prodrome she describes as a "weird feeling," then a headache follows over her right eye with nausea and vomiting. She has these headaches as frequently as 4 to 5 times a month, but recently she only gets them once a month prior to her menstrual period. In the summer of 1996, she began taking