54 year old female complaining of headache and visual field disturbance with sound to her left ear, seen initially by a neurologist.

The patient is a former migraineur, whose migraines have subsided post menopause. She describes a different type headache in the past 6 months. When she bends forward, coughs, laughs, valsalvas or otherwise exerts, and sometimes on moving her head, she has severe throbbing pain at the top and right sides of her head.

For the past 6 years she has observed that sometimes sound to her left ear (e.g. using the phone left) causes her vision to “move up and down.”

She had a head injury at age 7 without loss of consciousness, and no other nor recent head injury or serious illness.

Turning left causes dizziness.  She has a tendency to fall to her left.  She reports some tingling around the mouth, which is episodic.

She has tachycardia hstory and reports some problems with her heart valves.

In reviewing her history and presenting symptoms, what are you suspecting?  Specifically –

• What would exertional headache potentially be related to?  And, when does a person naturally valsava in the course of a day that would trigger that headache?
• What does the sound-induced vision change potentially suggest?
• What does motion provoked dizziness correlate with?

This case is courtesy of Geoffrey Waite, NSU AuD student. The preceptor was Tish Gaffney, AuD, also of NSU.