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1 Senior House Officer in Neurology
2 Specialist Registrar in Neurology
3 Consultant Neurologist
4 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
5 Consultant Endocrinologist, Metabolic Unit, Western General Hospital, Edinburgh, UK
Correspondence to:
Dr M Simpson, Department of Neurology, Western General Hospital, Edinburgh EH4 2XU, UK; marion.simpson@doctors.org.uk
| The first 150 words of the full text of this article appear below. |
A 42-year-old taxi driver was referred with a one-year history of headache. He was otherwise well with no significant past medical history and no other symptoms on systemic enquiry. He smoked 20 cigarettes per day. He described episodic headaches, occurring 2–3 times each week. Most were mild and responded readily to paracetamol. He described a typical headache as a throbbing pain, which started bifrontally and then spread to involve his whole head. Occasionally, he had a similar but more severe headache, associated with nausea, vomiting, photophobia and blurred vision: "the big one". Neurological examination, including fundoscopy, visual fields and visual acuities was normal. General examination was also normal and his blood pressure was 110/76.
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Question 1 What is the diagnosis?
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COMMENT
Headache is very common, affecting most people at some point in their lives. It is also one of the commonest presenting complaints in general neurology out-patient clinics. The history is the key
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