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

Helmi L. Lutsep, MD


February 10, 2022

Migraine is a complex neurologic disease that is characterized by recurrent episodes of headache, most often unilateral, and in some cases, associated with photophobia or phonophobia (a constellation known as an aura) that usually arise before the head pain but may also occur during or afterward. Migraine is most common in females and prevalence peaks between the ages of 25 and 55 years.

Symptoms of migraine include throbbing or pulsatile headache, with moderate to severe pain that intensifies with movement or physical activity; unilateral and localized pain in the frontotemporal and ocular area (though the pain may be felt anywhere around the head or neck); nausea and vomiting, leading to food intolerance and anorexia; lightheadedness; and sensitivity to light and sound. Typically, the pain builds up over a period of 1-2 hours, progressing posteriorly until becoming diffuse, and lasting 4-72 hours.

Migraine should be distinguished from other common headaches. Tension-type headaches usually cause mild or moderate bilateral pain, with a deep steady ache rather than the typical throbbing quality of migraine headache. With cluster headaches, the patient experiences attacks of severe or very severe, strictly unilateral pain (orbital, supraorbital, or temporal pain), but the cadence of these headaches differ from that of migraines; these attacks last 15-180 minutes and occur from once every other day to eight times a day. Patients with basilar migraine, common among female patients, usually present with symptoms of vertebrobasilar insufficiency.


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