DR SHIP: Mrs V has been generally in good health. About 7 days before her presentation, she developed an atypical headache. She also noticed difficulty opening her mouth, pain behind her eye, and some unusual lumps on her head. She recalls upper respiratory infection symptoms in the week before her headache. Her symptoms were intermittent. She had no fever or chills, no joint pain or weakness, and no systemic symptoms. She took no medications for her symptoms. She then woke with a booming headache and sought care. Her physician was concerned about her symptom complex; she started taking prednisone and a temporal artery biopsy was scheduled for the next day.