case_images: PMC11807410_01
case_images: Summary of medications tried for the patient's three headache types.. *Somewhat effective medications explained: A combination of caffeine, cyclobenzaprine, and diphenhydramine was mildly effective for the HH-type headache if taken before bedtime; sumatriptan successfully aborted migraine attacks; lithium reduced HH-type attacks from 4 per day to 3 per day; acetaminophen was effective for the PH-type headache if taken at 3500-4000 mg divided four times daily; oxygen provided variable effectiveness; and an occipital nerve block gave temporary relief (less than 1 day).. **Duloxetine was stopped quickly due to nausea and insomnia.. HH: Hypnic headache; PH: Paroxysmal hemicrania.
case_images: cureus-0017-00000077243-i01.jpg
case_images: PMC11807410_01_cureus-0017-00000077243-i01.jpg
case_images: FIG1
case_images: Contrast-enhanced T1-weighted fat-saturated brain MRI in the sagittal view shows a punctate focus of hypoenhancement (arrow) compared to the normally enhancing surrounding pituitary gland.
case_images: cureus-0017-00000077243-i02.jpg
case_images: PMC11807410_01_cureus-0017-00000077243-i02.jpg
case_images: FIG2
case_images: Both revealed a questionable pituitary adenoma (Figure 2) (the second MRI included thin cuts of the pituitary), as well as mild-to-moderate chronic microvascular ischemia, but were otherwise unremarkable.