Skill Checkup: A 20-Year-Old Woman With a Diffuse Pulsatile Headache, Neck Pain, and Nausea

Helmi L. Lutsep, MD


February 10, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 20-year-old woman presents with a diffuse pulsatile headache, neck pain, and nausea. Her height is 5 ft 4 in and weight is 130 lb (BMI 22.3). Describing her current state as the "worst headache of her life," she reports that her pain has been progressing for nearly 2 days, with vomiting on the first day, and she has not been able to eat full meals. She reports that she has experienced severe headaches in the past, sometimes with a sensation of "rainbow vision." These episodes last for about 2 days with little relief from taking nonsteroidal anti-inflammatory drugs (NSAIDs), even with dose intensification. Physical examination is notable for Adie-type pupil.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.