Headache accompanied by photophobia
Author and Disclosure Information [Show]

Angeliki Vgontzas, MD, Instructor, Department of Neurology, Harvard Medical School; Associate Neurologist, Department of Neurology, Brigham and Women's Hospital/Brigham and Women's Faulkner Hospital, Boston, Massachusetts.

Angeliki Vgontzas, MD, has disclosed no relevant financial relationships.

Question 1 of 3

A 28-year-old woman with a 12-year history of episodic migraines without aura presents for acute care with severe throbbing headache on the right side of her forehead accompanied by photophobia and nausea. The patient reports seeing numerous flickering dots throughout the visual field of both eyes as well as numbness and tingling of her lips prior to the headache. These symptoms last for approximately 40 minutes. She describes the headache as the worst she has ever experienced and states that any physical activity, even walking, exacerbates the pain. Previously, the patient had good treatment response with nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; more recently, a triptan was prescribed when those treatments became ineffective. The patient is not pregnant and takes hormonal birth control. Vital signs and neurologic examination are normal.

On the basis of what you know about this patient, what diagnosis do you suspect?

Transient ischemic attack

Migraine with aura

Basilar artery thrombosis

Visual snow syndrome

This quiz is not accredited for CME.

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