13th August 2024

A 32-year-old female presents to your headache clinic with a 4-month history of worsening headache

A 32-year-old female presents to your headache clinic with a 4-month history of worsening headache. She has been fully investigated for this symptom and has come to discuss her results:


Weight: 115 kg	Height: 5 ft 4 inches	HR 60 bpm	BP 114/59 mmHg	Oxygen saturations 99%


Hb 130 (115-160)	Plt 304 (150-400)	K⁺ 4.8 (3.5-5)	Creatinine 79 (45-84)
WBC 5.8 (4-11)	Na⁺ 137 (135-145)	Urea 5.2 (4-7)	CRP 2 (<5)


MRI head: empty sella	Optic disc photographs: normal optic disc
MR venogram of the head: bilateral venous stenosis of transverse sinus	Lumbar puncture opening pressure: 27 cmH₂O (5-20) CSF culture: negative

MRI head: empty sella

Optic disc photographs: normal optic disc

MR venogram of the head:

bilateral venous stenosis of transverse sinus

Lumbar puncture opening pressure: 27 cmH₂O (5-20)

CSF culture: negative

What is the most appropriate 1st line management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.