Atypical headaches are uncommon and require special consideration by a primary care physician. We report the case of a 37-year-old male, who presented to the family medicine practice with persistent headaches which subsided postprandial and was later hospitalized for stroke-like symptoms. The lumbar puncture (LP) suggested viral etiology; however, cerebrospinal fluid (CSF) yielded no evidence of a specific virus. The patient computed tomography (CT) was non-diagnostic and magnetic resonance imaging (MRI) confirmed no acute intracranial abnormalities. Electroencephalogram (EEG) showed no definite epileptiform discharges, electrographic seizures, or evidence of non-convulsive status epilepticus. He was started empirically on intravenous (IV) acyclovir 800 mg Q6 for 10 days, followed by another 10 days of oral valacyclovir 500 mg twice a day (BID) antivirals leading to a complete resolution of his symptoms and confirming the diagnosis as viral encephalitis. This case is unique in its presentation due to the postprandial resolution of the patient's headache with no evidence of a specific virus in the CSF. In primary care setting, headaches are often referred routinely to neurologist for further management. However, more insidious causes for a headache, such as viral infections, should not be ruled out; and if the symptoms are acute and severe, an immediate inpatient work-up with empiric treatment for the most probable etiology may be warranted, despite unequivocal exam and laboratory findings.
Keywords: Primary care; case report; headache; viral encephalitis.
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