The patient with worsening migraines
Alison is a 43-year-old woman who presented with increasing frequency of her classical migraine. She reported migraines on four of the preceding five days, with a baseline frequency of 2-3 migraines a year.
Each day she had woken up without pain, before noticing a visual aura. On most days, she then went on to develop a characteristic hemicranial headache with nausea.
Past medical history includes idiopathic (familial) hyposplenia and polycystic ovarian syndrome. There were no exogenous oestrogens and Alison is a non-smoker.