Shari is a 19-year-old university student who presents with three weeks of intermittent frontal headache. 

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<p>Shari is a 19-year-old university student who presents with three weeks of intermittent frontal headache.</p><p>This is worst first thing in the morning and is associated with nausea, vomiting and reduced appetite.</p><p>There are no associated focal neurological or visual symptoms, nor any fever or weight loss.</p><p>Shari is well with no past or family history of note and has a normal BMI.</p><p>She uses topical benzyl peroxide for acne. The only finding of note on examination is pictured (right fundus shown; similar findings are present on the left).</p><p>Visual and ocular examination is otherwise normal, as is neurological examination.</p><p>Blood tests including FBC, urea and electrolytes, inflammatory markers, thyroid function, morning cortisol, parathyroid hormone, calcium, phosphate and vitamin D are normal, as are MRI and MRV brain.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.