The SNNOOP10 mnemonic is readily utilized as a diagnostic screening tool for these situations (Table 1). When someone presents with an acute change in a previously existing headache disorder, it can be an optimal time to reevaluate for red flags that warrant assessment and determination of whether a secondary headache is now at play. Beyond trying her usual rescue medications-sumatriptan and combination acetaminophen, aspirin, and caffeine-she was evaluated in the emergency department where her headache was minimally responsive to rescue infusions of fluids, ketorolac, prochloperazine, and diphenhydramine. C urgently returned to clinic stating that she suddenly developed the вЂњworst headache of her life.вЂќ Although the location of her pain was unchanged, it was now increased in severity with new onset dizziness, cognitive fogging, and blurry vision in addition to the nausea, photophobia, and phonophobia associated with her chronic migraine. CвЂ™s migraine attacks significantly, and she was also able to successfully wean off acute treatment with an acetaminophen, aspirin, and caffeine combination.ДЄpproximately 1 year later, Ms. OnabotulinumtoxinA injections were initiated for treatment, according to the Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) protocol. Although beta-blockers were contraindicated considering that she had ongoing asthma, topiramate and nortriptyline were both trialed and neither found tolerable for Ms. She initially presented to our clinic with chronic migraine and medication-overuse headache.

C, age 35, began to have bothersome headaches in her late 20s.

Radiculopathy after blood patch