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.
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