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A 46-year-old woman was referred for a headache problem for at least 25 years. Started with episodic headaches once or twice a week, became chronic and near daily 5 years ago and can now report 1–2 monthly episodes of additional severe unilateral headaches with aggravation by physical activity especially in relation to menstrual period. These “migraine-like” headaches responded very well to triptans, whereas the “normal” headaches were nonresponsive. She was referred to the headache clinic for a refractory chronic headache. Her physical and neurological examination was completely normal besides severe tenderness in the pericranial muscles, especially in the trapezius and splenius muscles in the neck. Her blood pressure was 140/86 mmHg and the pulse rate was 82 beats/min. A prior CTC was also normal. A diagnostic diary is presented in Fig. 21.1.
KeywordsMedication Overuse Idiopathic Intracranial Hypertension Simple Analgesic Posttraumatic Headache Tetracyclic Antidepressant