A 29-year-old lady was referred to the pain clinic by her family doctor. She reported suffering constant tiredness and low mood for five years. She also reported suffering from one sided headache particularly coming up to the time of her periods. Sometimes she had a sensation of the headache coming on for several hours before it started. When questioned further, she reported that the headaches were associated with nasal congestion and flushing of her face. She also reported that at times the headaches were more diffuse and lasted many days rather than having a cyclical nature. Her neck felt stiff and painful at times. She slept poorly. Her periods were very heavy and she had very little energy all of which went on trying to look after her two young children. She had gained weight in the past five years and had a BMI of 35.
When questioned about her medication, she reported that she took over the counter preparations only for her headaches and was taking paracetamol or Co-Codamol 8/500mg tablets and Ibuprofen most days. She was being prescribed Citalopram 20mg once daily for her low mood and anxiety for the past two years but did not think it made a difference to her mood. She had never seen a physiotherapist for her painful neck. She had had a short course of Cognitive behaviour Therapy for her mood from the local Well Being Service.
- Is there any other information you would like to know?
- What are the potential differential diagnoses?
- Are there further investigations that would be helpful?
- Would this patient benefit from evaluation by another speciality?