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A 47-Year-Old Woman With Tension-type Headaches
K. M. A. Welch, MD, Discussant
JAMA. 2001;286:960-966.
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INTRODUCTION
DR BURNS: Ms T is a 47-year-old divorced librarian with a long history of headaches. She primarily receives treatment from Dr D, an anesthesiologist and neurologist at Beth Israel Deaconess Medical Center. She has managed care insurance.
Ms T had her first severe headache at 4 years of age, and she has had headaches regularly (1-4 times per year) since the age of 15 years. Over the years, her headaches became more frequent except for the 2 years when she was pregnant and nursing her child. Ms T saw multiple neurologists and received, at varying times, metoclopramide, prednisone, methysergide, amitriptyline, low-dose verapamil, isometheptene/dichloralphenazone/acetaminophen (Midrin), propranolol, ergotamine/belladonna/phenobarbital (Bellergal-S), diazepam, sumatriptan, aspirin/butalbital/caffeine (Fiorinal), pseudoephedrine, and dihydroergotamine. Her past medical history was otherwise unremarkable except for sinus problems and depression prominent particularly during her menses. She had normal findings on a magnetic resonance imaging (MRI) scan of . . . [Full Text of this Article]
MS T: HER VIEWS
DR D: HIS VIEWS
AT THE CROSSROADS: QUESTIONS FOR DR WELCH
Epidemiology and Pathogenesis Diagnosis Specific Considerations Differential Diagnosis Treatment
QUESTIONS AND DISCUSSION
Author Affiliation: Dr Welch is Vice Chancellor for Research, University of Kansas School of Medicine, Kansas City.
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