Skill Checkup: A 21-Year-Old Woman Presents With a Severe, Localized Throbbing Headache and Lightheadedness

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 21-year-old female patient presents with a severe, localized throbbing headache and lightheadedness. She is nonfebrile. Her height is 5 ft 5 in and weight is 148 lb (BMI 24.6). The patient has begun keeping a headache log, reporting that for the past several months, about half of her days have been headache days. These episodes have begun to affect her academics and social life. As a student, she notes that her symptoms often come on "at the worst possible time" shortly before exams and major assignments. The patient takes nonsteroidal anti-inflammatory drugs (NSAIDs) at the first sign of these episodes, a symptom that she describes as vision sensitivity. But even with increased dosage, they have not been able to curtail the current attack, which has been progressing for over a day and has become diffuse.


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.