A 25-year-old female presents to her primary care physician with complaints of muscle
tension, especially in her shoulders and neck, contributing to tension headaches, She
describes decreased sleep, chronic fatigue and constant restlessness in addition to poor
concentration at work, with repeated run-ins with her coworkers. She has been a worrier
since childhood, with worsening bouts when under stress. Physical exam reveals a healthy,
tense female with normal vital signs and generalized muscular tension. She does not abuse
substances, and medical history is unremarkable,