Question: I have a migraine every morning. I’ve had it for several months now. I’ve always had them, but not like this. I’ve noticed if I blow my nose in the middle of the night or right before bed then I wake up in the night with a...

By Elizabeth Loder, M.D., F.A.C.P. Director, Headache and Pain Management Programs Spaulding Rehablitation Hospital, Boston, MA THE CASE A 32-year-old woman was referred by her primary care doctor to a headache clinic. She reported a history of "normal headaches" until four months before her appointment. At that time she began to have mild, generalized headaches that she described as "achy" and which became more frequent and intense. In fact, over the last two months, she has had a constant headache. No one in her family has a history of headache problems, although the occasional blurry vision that she has experienced since the headaches began makes her wonder if her problem is migraine with aura, a condition she learned about on an online headache information site. A CT scan of her head showed no abnormalities. The headache specialist who evaluated this patient was concerned by the rapid progression of her headache syndrome, and wanted to know if the patient had a history of rapid weight gain, was on any medications for other conditions, or had any other unusual symptoms. When the patient noted that she was on tetracycline as treatment for acne, and occasionally heard "whooshing sounds" in both ears, the doctor examined her eyes with an ophthalmoscope, and then recommended a lumbar puncture (spinal tap) to help diagnose her condition. The doctor also noted that the patient was overweight.