Differential Diagnosis A 42-year-old woman has had occasional headaches for 20 years, which she attributes to drinking beer. For the past 2 years, she has also been getting headaches during extremely hot weather about 45 minutes into mowing her lawn with a push mower. The frontal headache, which lasts about 3 hours, responds partially to acetaminophen, but no off-the-shelf medication has worked to her satisfaction. Similar headaches have occurred inconsistently with her workouts. She exercises indoors and finds that a fan reduces the likelihood of a headache. She has never had a headache with coughing or sexual activity, a sudden explosive headache, or a headache relieved by lying flat or in any other position. She does not recall one-sided headache, throbbing, or vomiting, but from time to time has had stomach queasiness she attributed to medicines. The patient is in good health, and her general and neurological examinations are normal. What is your preliminary diagnosis? What are your differentials? Give your rationales for your differentials. How can you confirm your differentials? What are the causative agents? How would you treat this patient? Include diagnostics as well as medications and dosingDifferential Diagnosis A 42-year-old woman has had occasional headaches for 20 years, which she attributes to drinking beer. For the past 2 years, she has also been getting headaches during extremely hot weather about 45 minutes into mowing her lawn with a push mower. The frontal headache, which lasts about 3 hours, responds partially to acetaminophen, but no off-the-shelf medication has worked to her satisfaction. Similar headaches have occurred inconsistently with her workouts. She exercises indoors and finds that a fan reduces the likelihood of a headache. She has never had a headache with coughing or sexual activity, a sudden explosive headache, or a headache relieved by lying flat or in any other position. She does not recall one-sided headache, throbbing, or vomiting, but from time to time has had stomach queasiness she attributed to medicines. The patient is in good health, and her general and neurological examinations are normal. What is your preliminary diagnosis? What are your differentials? Give your rationales for your differentials. How can you confirm your differentials? What are the causative agents? How would you treat this patient? Include diagnostics as well as medications and dosing
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