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

Heidi Moawad, MD


August 08, 2022

Narcolepsy, particularly narcolepsy type 2, can present with symptoms that patients may ignore for years. Additionally, the initial evaluation may be focused on ruling out more concerning conditions in the differential diagnosis, such as causes of pain or conditions in a patient's family history. Referral to a sleep specialist is not always the first step in the diagnostic process. With treatment, many patients can experience an improvement of symptoms, but most patients may continue to feel more tired during the day than their peers. Treatment doses may need to be adjusted at times throughout the disease course.

The patient in this case had a good response to modafinil and felt less sleepy during the day. She was able to stay alert and enjoy more leisure activities during the weekends, but she maintained her early bedtime on workdays. She also incorporated lifestyle modifications to help control her symptoms. She followed a regular sleeping and waking schedule, and she often took one nap lasting between 30 and 45 minutes during her lunch break, with her supervisor's advance permission. She continued her regular exercise routine and dietary habits. Because of her condition, she decided that she will keep her job for as long as she can. She expressed some anxiety, however, about whether she would be able to adjust eventually to lifestyle changes that could occur in the future — particularly, changing jobs if necessary or having children, which she would like to do someday.


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