A 21-year-old woman presented to the surgery with a 3-month history of headaches. The headaches were becoming more frequent and were associated with intermittent vomiting. They did not improve with simple analgesics. The patient had a strong family history of migraine. After history and examination the patient was initially diagnosed with migraine. The diagnosis was explained and she was treated with sumatriptan. The patient returned 2 weeks later. Sumatriptan had not helped and the patient and her family asked for a referral. Further history revealed fatigue, occasional dizziness and irregular periods all coming on around the same time as the headaches. On general examination, the patient appeared well with a grossly normal cranial nerve examination. However, confrontational visual field-testing revealed bilateral inferior field defects. There was no ophthalmople-gia, pupils were equal and reactive to light and there was no afferent pupillary defect. Routine observations were all within normal range.
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