A 39-year-old North African housewife without any previous health problems came to our headache centre with a 4-week history of sudden-onset, bilateral (mainly right side), severe headache. Pain was continuous and fluctuating in severity, with associated photo- and phonophobia, not worsened by physical activity or exercise and not disabling with partial benefit from NSAIDs. Primarily, she was referred by her family doctor to the ENT specialist for evaluation. In the absence of clinical abnormalities, a cerumen plug from the left ear (suspecting a sinus headache) was removed without any other indication. A few days later, she also started experiencing fluctuating then permanent horizontal diplopia, so that she was referred to the local headache centre.
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