14.1 Headache not elsewhere classified

Identification: Female patient, 45 years old, with atypical headache for 4 months, without a defined diagnosis after complete investigation.

History of Present Illness:
Pain Characteristics:
Location: Bifrontal and alternating occipital
Characteristics: Continuous pressure (5-7/10 VAS) with pulsatile exacerbations (8/10), no clear temporal pattern
Duration: 4-12 hours/day

Associated Symptoms:
Non-vertiginous dizziness
Visual fatigue
Absence of nausea, photophobia, or aura

Relevant History:
Controlled hypothyroidism (levothyroxine 50 μg/day)
No previous history of primary headaches
Mild cervical trauma 6 months ago (no altered imaging)

Physical/Neurological Examination:
Craniocervical Assessment:
Mild tenderness on palpation of suboccipital muscles
Preserved cervical range of motion
Neurological Examination:
No motor or sensory deficits
Normal and symmetrical reflexes
Fundoscopy:
No papilledema or vascular changes

Complementary Exams:
Brain and Cervical Spine MRI:
No structural lesions
Mild C5-C6 disc degeneration without compression
Transcranial Doppler:
Symmetrical cerebral vascular flow
Laboratory:
TSH: 2.5 mIU/L
Normal complete blood count, C-reactive protein, and lipid profile