Reccurent Headaches in a 31-yr-old Woman

Review of Systems

  • General: She denies weight change and fevers but does feel generally fatigued.

  • Skin: Noncontributory

  • HEENT: She has noted occasional bilateral nontender swelling of the neck associated with the headaches. She denies any vision changes, lacrimation, nasal congestion or discharge, tinnitus, earache, discharge from the ear, sore throat, tooth pain, and facial flushing.

  • Pulmonary: Mild shortness of breath sometimes accompanies her palpitations and neck swelling, but she has no other respiratory symptoms.

  • Cardiovascular: Patient reports palpitations that occur during headaches. Palpitations last from a few minutes to several hours and resolve spontaneously. She has no chest pain with the palpitations or at other times. Her exercise tolerance is normal when she is asymptomatic.

  • Gastrointestinal: Patient complains of nausea associated with the headaches but no vomiting. She denies abdominal pain, and her bowel movements have been normal except for one episode in which she felt as though she was going to faint while straining on the toilet.

  • Genitourinary: She has occasional left flank pain but no dysuria or hematuria. Last normal menstrual period was 2 wk ago; duration and flow were normal.

  • Musculoskeletal: She has no muscle aches, joint pain, or stiffness.

  • Neurologic: She reports a single episode of transient right-sided arm weakness and altered sensation that followed one of the headaches. The weakness lasted < 1 h and resolved completely. Patient denies photophobia, phonophobia, and neck pain. She has had no previous head or neck injury.

  • Psychiatric: She reports episodes of feeling suddenly anxious even when sitting relaxed in the evening.