CLINICAL HISTORIES Case 1.—This is a 42-year-old woman who developed a right nuchal-occipital throbbing and vice-like headache with an intensity of 10/10 at the onset while sitting with nausea, vomiting, and a spinning sensation but no hearing loss, pressure in the ears, tinnitus, or other neurological symptoms 5 months previously. The headache had an intensity of 10/10 for about 3 weeks. Since then, she has had a constant headache described as a right nuchal-occipital and right hemicranial aching, throbbing, and stabbing with an intensity ranging from 4 to 8/10, with an average of 3-5/10 with nausea at times, and light and noise sensitivity, but no vomiting, visual symptoms, or vertigo since the first day. She had intermittent true vertigo lasting up to 30 minutes initially on a daily basis that did not totally resolve for about 6 weeks. She was taking baclofen 10 mg in the morning and 20 mg at bedtime that decreased the pain. She tried eletriptan 40 mg that dulled the pain. Three years previously, she had a mild head injury resulting in headaches for 3 weeks following but no other history of headaches. There was a past medical history of asthma. She initially saw her primary care physician who prescribed oral ketorolac and promethazine without benefit. A computed tomography (CT) scan of the brain without contrast 4 days after onset was negative. She then saw a neurologist who placed her on topiramate that was titrated up to 200 mg daily with mild benefit.A complete blood count, comprehensive metabolic panel, thyroid function tests, erythrocyte sedimentation rate (ESR), antinuclear antibody, and magnetic resonance imaging (MRI) and magnetic resonance angiogram (MRA) scans of the brain were normal. She had a normal evaluation by an otorhinolaryngologist including an audiogram and electronystagmogram. I saw her in headache consultation 4 weeks after onset. A neurological examination and an MRA of the brain and neck, MRV of the brain, and MRI of the brain with and without contrast were normal. Topiramate was increased to 300 mg daily that mildly decreased the intensity of the pain, allowing her to work. Although consideration was given to a trial of From the Montefiore Headache Center, Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA (M.S. Robbins); Baylor College of Medicine, Houston, TX, USA (R.W. Evans).