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.
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Cite this: Helmi L. Lutsep. Skill Checkup: A 20-Year-Old Woman With a Diffuse Pulsatile Headache, Neck Pain, and Nausea - Medscape - Feb 10, 2022.