For the past 6 months, the patient has reported worsening pain intensity, with daily moderate intensity (6 out of 10), with episodes of severe intensity (8 out of 10) about three times per month. He denied nausea, vomiting, photophobia, phonopho­bia, osmophobia, motor or visual changes before or during the attacks. He also denied worsening pain with movement. Furthermore, he reported worsening fatigue, with a more depressed mood and daytime sleepiness (Epworth 10), despite adequate sleep. In addition, he noticed that since the onset of the condition he had gained about 6kg for no apparent reason, associated with persistent constipation, hair loss, drier skin than usual and greater sensitivity to cold, although without change in body temperature. He has been using propranolol 80mg/day for 3 months, pre­scribed by the primary care doctor, without improvement in his condition. During pain crises, she used Paracetamol 750mg about three times a week, with partial improvement of the pain. She denied using other medications during the period. Due to the persistence of the headache, there is a signicant deterioration in quality of life and work performance. Regarding her medical history, she denies having had frequent or similar headaches in the past. She denied having had previous surgeries, smoking, or drinking alcohol. She works as a secretary in an accounting ofce and reports a sedentary lifestyle and a diet rich in carbohydrates. Her mother has hypo­thyroidism in her family. She denied migraine or other chronic diseases in the family.