A 50-year-old black woman with headaches was diagnosed with dural arteriovenous malformation located in the clival vein with extensive feeders in the contralateral right petrous jugular, ascending pharyngeal arteries, meningeal vessels, and right and left internal and external carotid arteries. She underwent embolization with polyvinyl alcohol particles and Guglielmi detachable coils. She continues to complain of severe headaches, dizziness, and loud pulsatile tinnitus. A follow-up angiogram revealed normal blood flow. Referral for otolaryngologic consult was no help. Where do I go from here?
—Gladys McGlon, ARNP-C, MSN, BC, Lee’s Summit, Mo.

If there is no further neurologic, neurosurgical, or otolaryngeal intervention that is necessary or beneficial, look toward alternative therapies. However, treating hypertension, avoiding alcohol and caffeine, and doing aerobic exercise may help. Acupuncture and some homeopathic medications have been reported to be beneficial, but these lack rigorous scientific data.
—Norma M. Keller, MD (99-13)

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