Level 1: Headache – Contrasting Case #1: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 36 year-old female who presents with the same chief complaint, frequency and duration of symptoms.

Differences to the long case presentation: Location is initially unilateral and frontotemporal/ocular, but can progress posteriorly and become diffuse. Quality is described as pulsatile. Headaches are associated with nausea, occasional vomiting, photophobia and phonophobia. Headaches are typically preceded by prodromal aura, described as a visual phenomenon of an arc of absent vision replaced by flashing or shimmering light.

All other history and physical exam elements are the same as in the long case.