Headache and dizziness in a 54-year-old man

• Medical history: 10-year history of migraine headaches controlled with sumatriptan. History of head injury while pole vaulting in high school, with brief loss of consciousness, diagnosed as concussion, and post-concussion syndrome (occasional headache, sleepiness) for about a year after the injury; no symptoms since.


• Surgical history: None


• Medications: Sumatriptan for migraine; occasional ibuprofen for headache or muscle pain.


• Allergies: Seasonal rhinitis; no medication allergies.


• Family history: Mother died at age 84 from pancreatic cancer; father died at age 97 from cardiac arrest. No neurologic disease in 1^st-degree relatives, but a first cousin died at age 24 of glioblastoma.


• Social history: Patient is employed as general counsel to a large accounting firm; he adheres to a low-fat, low-cholesterol diet. He bicycles some every day and up to 50 miles a day on weekends. Drinks occasional wine with dinner, never smoked, denies other drug use. No recent international travel but travels often domestically for his job. He is married and has one daughter. He receives an annual flu vaccination at his job, and he has completed vaccination for COVID-19.