Dizzy 2

Nervous System & Special Senses

Step 1: View Clinicals

A 16 year old boy presents with a severe, throbbing headache which started suddenly and has lasted for around an hour.

The headache started at the back of his head and then extended frontally. He also experienced nausea, dizziness and blurring of vision.

He had experienced a similar headache twice in the past 2 months.

His medical history is unremarkable and he has no allergies. His father has had episodic headaches in the past.

Step 2: Order Relevant Investigations

1. MRI + MRA Brain


The MRI + MRA is normal, with no evidence of space occupying lesions, hemorrhages or aneurysms.

2. Lumbar puncture


Xanthochromia: absent

WBC: 3/mm3 (0 - 5)

Protein: 47 mg/dL (15 - 60)

Glucose: 73 mg/dL (50 - 80)

3. EEG


No epileptiform activity is noted.

4. Toxicology Screen


The toxicology screen is completely unremarkable.

Step 3: Select Appropriate Management

1. Sumatriptan


2. Indomethacin


3. Antiemetics


4. Verapamil