13th August 2024

A 27-year-old male runner presents to your clinic with a 4 month history of headache after exercise

A 27-year-old male runner presents to your clinic with a 4 month history of headache after exercise. He tells you that after he finishes a run he gets a bilateral pulsatile headache which develops over 30 minutes and lasts for 12-24 hours in total. These symptoms mean that he has been avoiding running recently. He does not get the headache at any other times and never wakes up with the headache. He denies headaches on coughing or bending forwards. He denies any other neurological symptoms. He has no history of head injury. His neurological examination is completely normal and he appears well. You see he has already had an MRI brain and a MR angiography brain which are both unremarkable.

What is the most likely diagnosis?

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