Pound of flesh piercing ear practice
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Later, she could not follow up with her neurologist or headache specialist due to insurance issues. Her prior primary care provider had also tried topiramate and amitriptyline without significant benefit. She tried multiple over-the-counter medications such as Excedrin without any relief. She states that about four years ago, she had headaches in the left occipital region, which lasted almost six weeks. The headaches improved in her late 20s and 30s but recently have worsened again. She saw a neurologist in her teens and was diagnosed with cluster headaches. There was no preceding history of any injuries, falls, or head trauma. She usually drinks two cups of coffee per day, and this practice has not changed in many years. She denies a family history of headaches. Later, the headaches also started occurring at night and waking her up from sleep. She could not identify any triggers but stated that initially, the headaches would only occur during the day. She denied visual aura, ptosis, diplopia, blurry vision, nausea, vomiting or sensitivity to smell, dysphagia, dysarthria, dizziness, weakness, numbness, or tingling or any other neurological deficit. Associated symptoms included nausea, photophobia, and phonophobia.
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She denied any tearing but did endorse nasal congestion on the side of the pain. The pain was mostly in the occipital or the periorbital area. She typically described her headaches as a pressure sensation that would last from 10 to 30 minutes and occur about 6-8 times per day. The patient stated that she started having headaches around the age of 10, which became frequent around her teens and early 20s. Our patient is a 47-year-old right-handed female who presented to the Family Medicine clinic for evaluation of her headaches.