1.3 Chronic migraine

A 31-year-old plumber reports episodes starting with an odd tingling down one side of his tongue, followed shortly after by a burst of ringing in both ears together with noticeably slurred speech for a few minutes, the two features arriving one after the other rather than at once. The headache, when it comes, follows within the hour: a dull, tightening pressure around the head, not the throbbing pain he sometimes gets separately. He recalls at least eight full episodes of this kind over his lifetime. Aside from these, he has been troubled for roughly the last four months by a similar dull, tightening headache occurring on about eleven days most months, with no accompanying ear or speech symptoms on those days.