A 32-year-old man presents to his neurologist with a history of new-onset right-sided occipital head and neck pain. His medical history is significant for clinically isolated syndrome, anxiety, and frequent migraine headaches since his early twenties. His migraine headaches occur about three times per month and are heralded by typical visual aura half the time. The pain is unilateral usually on the left, pulsatile, and severe. Headaches are associated with prominent nausea and sensitivity to light. Three years ago, he had an episode of right leg weakness, blurry vision in his left eye, difficulty with depth perception, and pain on lateral eye movements that lasted several weeks. On the basis of his symptoms, neurologic deficits, and imaging, clinically isolated syndrome was suspected at the time and he received a course of IV Solu-Medrol with resolution of his symptoms.
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