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Clinical Crossroads |

A 47-Year-Old Woman With Tension-type Headaches

K. M. A. Welch, MD, Discussant
JAMA. 2001;286(8):960-966. doi:10.1001/jama.286.8.960.
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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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