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Case Records of the Massachusetts General Hospital
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Volume 359:2267-2278 November 20, 2008 Number 21
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Case 36-2008 — A 59-Year-Old Man with Chronic Daily Headache
Steven D. Brass, M.D., M.P.H., Marlene L. Durand, M.D., John H. Stone, M.D., M.P.H., John W. Chen, M.D., Ph.D., and James R. Stone, M.D., Ph.D.

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Presentation of Case

Dr. Adam B. Cohen (Neurology): A 59-year-old man was admitted to the neurology service of this hospital because of chronic daily headache, fever, and myalgia.

Approximately 6 months earlier, the patient had begun having headache, accompanied by muscle spasms, generalized myalgia, weakness, fatigue, difficulty sleeping, and anxiety. The headache was constant, affected both temporal and frontal regions, and was not affected by posture. The temperature rose daily but remained below 37.8°C. Five months before admission to this hospital, he saw his internist at another hospital. The physical examination was normal. Amitriptyline at bedtime was prescribed, without improvement. The patient took . . . [Full Text of this Article]

Differential Diagnosis

Chronic Daily Headache

Neoplasm

Headache Due to Low Cerebrospinal Fluid Pressure

Idiopathic Hypertrophic Pachymeningitis

Pachymeningitis Due to Infection

Rheumatologic Diseases and Pachymeningitis

Clinical Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Departments of Neurology (S.D.B.), Medicine (M.L.D., J.H.S.), Radiology (J.W.C.), and Pathology (J.R.S.), Massachusetts General Hospital; and the Departments of Neurology (S.D.B.), Medicine (J.H.S.), Radiology (J.W.C.), and Pathology (J.R.S.), Harvard Medical School.



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