A 16-year-old girl with a 6 months’ history of moderately severe headaches was referred to Wolverhampton and Midland counties Eye Infirmary (WMEI) for ophthalmological evaluation after her optician had noted swollen discs; she had seen the optician at the request of her general practitioner to rule out refractive error as the cause of headaches. She described the headaches as generalized, though more severe in the mornings. They did not worsen with coughing, sneezing, or physical activity and were unrelated to posture. She did not experience tinnitus or any whooshing auditory sensations. She denied nausea or vomiting and reported no visual symptoms.
According to her mother, she had gained about 10 kg in the previous 6 months. Her menstrual cycles were largely regular; she had neither dysmenorrhea nor menorrhagia. She presented to the hospital emergency department 7 months previously with right iliac fossa pain, which was attributed to constipation. She was discharged following dietary advice and laxatives, which relieved her symptoms.