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

Heidi Moawad, MD


August 08, 2022


Because of the patient's complaints of fatigue and her family history of thyroid disease, thyroid function tests were ordered. The normal test results and the absence of abnormalities (eg, goiter) and weight changes excluded any type of thyroid disorder. Although malnutrition can cause fatigue, her blood tests and weight were normal, which strongly suggests that her attention to diet was not causing malnutrition. When questioned about her mood, she did not have typical signs of depression; thus, depression was also ruled out.

The patient received a diagnosis of narcolepsy type 2. Because narcolepsy type 2 is not associated with low levels of cerebrospinal fluid hypocretin, she did not undergo a lumbar puncture to measure her level of hypocretin.

Narcolepsy affects approximately 40 per 100,000 people in the United States.[1] Narcolepsy type 2 is more common than narcolepsy type 1. The typical age of symptom disease onset is during the teenage years or 20s, although some patients may have symptom onset at an older age. Narcolepsy type 1 presents with excessive daytime sleepiness and episodes of cataplexy. Some patients may experience sleep paralysis or hypnagogic hallucinations. Patients with narcolepsy type 2 do not experience episodes of cataplexy.

The most prominent symptom of narcolepsy type 2 is excessive daytime sleepiness. Because this symptom is vague and nonspecific, many patients do not seek medical attention for the symptoms of narcolepsy type 2, which can delay diagnosis and treatment.

Excessive daytime sleepiness can have a substantial effect on daily life and may lead to low performance in school or at work, as well as difficulties in carrying out day-to-day responsibilities. Patients with narcolepsy have a high incidence of migraine and nonmigraine headaches.[2] Narcolepsy is also associated with generalized musculoskeletal aches and pains, including back pain, and poor dietary habits.[3]


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