A 24-year-old woman attended her GP surgery complaining of severe bouts of headaches that have come and gone over several months. She describes the headaches as pounding. During an attack, she feels anxious with palpitations and sweatiness. These episodes can last up to 20 minutes. There is no vomiting, visual disturbance or other neurological symptoms. She feels well between episodes and has no other medical problems. She has tried taking paracetamol and ibuprofen for the headaches but these did not seem to work.
She does not drink alcohol nor smoke. There are no significant illnesses in her family history. Examination A urinalysis did not show any abnormalities. She appeared sweaty and pale but there was no tremor or evidence of weight loss. Fundoscopy did not show papilloedema or other hypertensive changes. Her heart rate was 120/min and regular, blood pressure 220/110 mmHg and…
