A 55-year-old man comes to the physician because of daily headaches awakening him in the early morning. Often, the pain is exacerbated by straining during defecation . He has rarely had headaches before. Common analgesics, such as aspirin and non steroidal anti-inflammatory drugs (NSAIDs), have provided no benefits. The patient denies weight loss. He takes enalapril for moderately severe hypertension. Blood pressure is within normal limits at this time. Neurologic examination reveals mild hypoesthesia in the right hand and diminished strength in the right arm. Which of the following is the most appropriate next step in management?
A. Trial with differentNSAIDs
B. Change in antihypertensivemedication
C. Sumatriptan treatment
D. Neuroimaging studies
E. Lumbar puncture
A. Trial with differentNSAIDs
B. Change in antihypertensivemedication
C. Sumatriptan treatment
D. Neuroimaging studies
E. Lumbar puncture