Neurologic — Headache

A 30-year-old patient comes to your clinic complaining of headache for three days. The headache is constant, bilateral, and described as a pressing or band-like tightness rather than throbbing. She rates the pain as 3 out of 10 in intensity and says it is not made worse by walking or climbing stairs. She denies any photophobia, phonophobia, visual changes, or nausea. She has a history of similar headaches in the past, but they improved after she changed her eyeglass prescription. She recently saw an optometrist and her eyesight has been stable. On examination: blood pressure 120/85 mmHg, heart rate 80 beats per minute, temperature 98 degrees Fahrenheit, respiratory rate 12 breaths per minute. The rest of the physical examination is normal. There are no focal neurological deficits. The patient returns to the clinic after 8 months. She tells you her headaches have become almost daily and are more severe than before, even though she has been taking the medication you prescribed every day to manage them. Vital signs and physical examination are normal.