Clinical practice - Chronic daily headache

A 36-year-old woman with a long history of catamenial migraines had had a headache almost every day during the previous year. The background headache was mild but became severe and incapacitating at least twice a week, interfering with work and sleep. She took six to eight tablets containing a combination of aspirin, acetaminophen, and caffeine per day, with minimal relief. She had no fever, weight loss, diplopia, or tinnitus. Her headaches were not exacerbated by a Valsalva maneuver or positional change. Her physical examination was normal. How should she be evaluated and treated? Copyright © 2006 Massachusetts Medical Society. All rights reserved.