ABSTRACT
A 64-year-old woman presented to hospital complaining of worsening headaches. She described a 4-day history of an occipital headache, which she initially noticed soon after waking but was unsure whether the headache itself had woken her. She said the initial pain was around 4/10 in severity but had now reached 8–9/10. There was neither associated neck stiffness, nor any photophobia. The patient denied recent nausea and vomiting. Both paracetamol and ibuprofen slightly relieved the headache. She denied any recent trauma and had not experienced similar headaches in the past. The patient complained of recent difficulty threading a needle and sewing, which she did with her right hand, and said that she felt slightly unsteady on her feet when walking outdoors, which she thought may have been present for the preceding week. Tasks such as holding cutlery and drinking from a cup were not affected. Her past medical history included Sjögren's syndrome, rheumatoid arthritis affecting the small joints of her hands, and hypothyroidism. She took levothyroxine once daily but no other regular medications. She worked as a blood donor carer and lived with her husband and granddaughter. She had never smoked and denied regular alcohol intake.
