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

Heidi Moawad, MD


August 08, 2022

Physical Examination and Workup

Upon physical examination, the patient appears healthy and well nourished. Her vital signs are normal and not reflective of thyroid disease. Her weight is normal, and she has not had any recent weight changes. She is talkative and appears to have a normal energy level. No abnormalities are noted during her physical examination. When asked about her mood, she says she has not had any problems with sadness, hopelessness, or anxiety.

The results of a comprehensive metabolic panel and thyroid function test findings are normal. She has a brain MRI scan to rule out a serious cause of the headaches. The findings are normal. After this diagnostic testing, she is referred to a sleep specialist, who orders an overnight sleep study and a multiple sleep latency test (MSLT). Her overnight sleep study is read as normal, although she has a slightly shortened sleep latency. Her MSLT shows a short sleep latency, with rapid onset of REM sleep during her naps. She is asked about cataplexy, and she denies ever having any episodes of loss of muscle tone


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