A 27-Year-Old Woman With Constant Headache Too Tired to Party

Heidi Moawad, MD


August 08, 2022

Editor's Note:
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 27-year-old woman has had headaches since she was a teenager. She used to sleep them off, but for the past few years, she has been working at a 9-to-5 job and has not been able to take naps regularly or sleep late on weekday mornings. She describes her headaches as constant, mild, all over her head, and usually associated with sleepiness. She has never taken medication for them, and they usually resolve by the time she wakes up after a nap or after a night's sleep.

The patient is also concerned that she is tired all the time. She says that lately she has fallen asleep at her desk at work a few times each week. She usually goes to bed within a few hours after getting home from work, falling asleep at 7 PM or 8 PM and sleeping until morning.

She works as an administrative assistant at an athletic training center. Most of her work is done sitting at a desk, and she also performs approximately 2 hours of team coaching per day as part of her job. She runs with the team and does some weight-bearing exercises during the coaching. She says that she pays a great deal of attention to maintaining a healthy diet and avoiding additives, preservatives, and sugar.

Her educational background is in sports psychology. She explains that it took her5.5 years to graduate from college with a 4-year degree because she was unable to handle a full course load along with swimming for her college. However, she notes that such a prolonged college duration was unusual at the university she attended and that all of the other swim team members were able to graduate in 4 years.

She lives with a roommate who is a friend of a friend. She gets along with her roommate and with her own family. She has noticed that she is too exhausted for leisure activities and that she does not seem to have the energy to socialize or have fun. Her roommate and friends say she's always "too tired to party." She is not in a relationship and is not now nor has ever been pregnant.

The patient had several compression fractures that were attributed to sports injuries during high school, and they have healed completely. She has a family history of hyperthyroidism in her mother, who is treated with medication.


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