A 36-year-old woman comes to the office due to headaches. Over | Uworld | Step 2ck

A 36-year-old woman comes to the office due to headaches. Over the past 3 months the patient has had constant, bilateral headaches almost every day shortly after awakening. She has had intermittent episodes of migraines since adolescence, but her current headaches are more frequent though milder. The patient has been taking over-the-counter analgesics several times a day. She has had no focal weakness, numbness, or vision changes. The patient has no other medical conditions and does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. BMI is 24 kg/m2. Physical examination, including funduscopy and neurological examination, shows no abnormalities. Blood cell counts and serum chemistry studies are within normal limits.