a 19-year-old woman presents with worsening headaches. she reports a multi-year history of episodic throbbing headaches. they have intensified, and she now misses classes and work periodically as a result. the headaches occur about 4-6 times per month recently, up from 1-2 per month when she first started experiencing them. her headaches last 2-3 days and are accompanied by nausea, vomiting, and light sensitivity. after the headache resolves, she denies any residual symptoms. she denies neurologic symptoms, such as vision or taste changes, gait disturbances, and memory loss. she has tried multiple over-the-counter pain medications without relief. her mother and maternal aunt experienced similar headaches. she reports some increased stressors and less sleep since recently starting college.