The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 16-year-old girl presents to the emergency department with an acute-onset severe headache as well as nausea, vomiting, and intermittent diplopia. She feels dizzy while walking and cannot walk independently. She also complains of blurred vision. This is her first physician's visit for the headaches, which have been episodic during the past 2 weeks. The headaches involve her entire head. They are not throbbing, are not associated with an aura, and do not occur at a certain time of the day. The severity increases while coughing or straining. She has photophobia and photophobia during these episodes. The headaches previously responded to over-the-counter analgesics, but now she has intolerable pain unrelieved by medications.
She has no significant medical history except for minor head trauma while cycling 1 month ago. Her only medication is an oral contraceptive that she has taken for 2 years. She does not use illicit drugs. The family history is positive for atypical migraine headaches; her mother has been treated with medications for this condition for years.
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Cite this: Payman Vahedi, Zahra Mohajernezhad, Mohammad Faraji-Rad. Seizure After Sudden Headache in a 16-Year-Old Cyclist - Medscape - Mar 25, 2022.