13th August 2024

A 34-year-old female is referred to the neurology clinic by her GP. She has been experiencing headaches

A 34-year-old female is referred to the neurology clinic by her GP. She has been experiencing headaches for the past 9 months. The headaches are throbbing in nature and often present in the mornings when she wakes up. Sometimes, she has blurred vision when the headache is present. She has tried simple analgesia such as paracetamol, aspirin and ibuprofen with no improvement. She has a past medical history of bipolar disorder and takes lithium. On examination her temperature is 36.9 degrees Celsius, BP 133/74 mmHg, HR 89 bpm, oxygen saturations 97% on room air. Her BMI is 31. Cranial nerve exam shows bilateral swelling of the optic disc. Visual fields and acuity are intact. MRI head and MR venogram are normal. A lumbar puncture is not tolerated by the patient.

What would be the most appropriate next management steps?

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