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JAMA Clinical Challenge

Frontal Headache

Image of Frontal Headache
Left, Cranial computed tomography showing discrete obliteration of the sulci. Right, Fluid-attenuated inversion recovery magnetic resonance imaging showing hyperintensity in the frontal, temporal, and occipital lobes (figure reprinted from Arch Neurol. 2010;67[12]:1516-1520.)

Huan J. Chang, MD, MPH
Gianna Zuccotti, MD
A 47-year-old Brazilian woman presented to a walk-in clinic reporting a headache of 8 days' duration that started in the frontal area and evolved into a holocranial headache. The intensity progressively worsened, and she developed vomiting 2 days earlier. She denied having a fever. Past medical history was significant only for systemic arterial hypertension. There was no history of diabetes mellitus or other comorbidities. She did not drink alcohol. Physical examination revealed mild neck stiffness and a nonfocal neurological examination. Funduscopy findings were normal. The patient had no lymphadenopathy, fever, or skin alterations. An emergency cranial computed tomographic scan showed discrete sulcus obliteration (Figure 1, left). Magnetic resonance imaging (MRI) showed hyperintensity in the frontal, temporal, and occipital lobes (Figure 1, right).

See the full article for an explanation and discussion.

Author Affiliation: Dr Chang (tina.chang{at}jama-archives.org) ) and Dr Zuccotti are both Contributing Editors, JAMA. Dr Zuccotti is also with Partners Healthcare, Boston, Massachusetts.