So Dr. Chopra, this is our third best case ever in the Best Case Ever series.

This one's going to be released before our episode on headache, pearls, and pitfalls.

So Dr. Chopra, let it rip.

Let us know what your best case ever is.

Well, I remember very clearly this 26-year-old, black female, otherwise healthy,

visited us in the emergency department for the third time.

So, as you can imagine, it was already a red flag.

The resident went to see the young lady who was coming back with essentially refractory headaches,

despite having been given a prescription for a citaminophen

and codeine on two previous visits was advised to take some nonsteroidal anti-inflammatory

drugs and there didn't appear to be any particular red flags in the past about a subarachnoid

hemorrhage, a meningitis.

On the first visit, she had had a CT and an LP because there was the consideration given the

fact that she had a new headache which she didn't suffer from headaches before and newer

imaging didn't reveal the cause. So a lumber

puncture was done at the time. She presented the second time afterwards and was treated as a post-LP

headache. Even though reading through the notes of her second visit, it certainly didn't seem like she had much of an improvement with the analgesia that she was given on the second visit.

So she came to us the third time, and we were concerned this is a relatively healthy lady.

She was a little bit obese, and she was on a birth control pill. We had ruled out any

pregnancy associated illness before, i.e. she had had a negative pregnancy test before. The

resident saw her, didn't find much except her complaining of a headache, a diffuse global headache,

photophobia, no meningism. And she was given

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