Janelle, a 75-year-old retired lawyer, presents to her GP with a two-month history of headaches.

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Janelle, a 75-year-old retired lawyer, presents to her GP with a two-month history of headaches. The headaches come most days, start at the back of her neck and radiate around her head, with an associated mild pressure feeling. She rates the pain as 2/10 severity, rarely takes paracetamol for it and has found remedial massage a useful form of treatment.

Janelle reports no associated nausea, vomiting or red flag symptoms. She is euthymic, although somewhat stressed as her eldest daughter is going through an acrimonious divorce, and she reports her headaches began after hearing this news. Janelle is normotensive and apyrexial. Her neurological examination is unremarkable.