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  #1  
Old 07-20-2011
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Question How would you treat this headache!

A 50 y/o man suffers from headaches. They occur in periodic cycles, only several months out of the year, with 1-2 headaches attacks per day. The headaches are severe; located behind the right eye; and are associated with a red, tearing, right eye and nasal stuffing on the same side. Which of the following is the best first step in management?

A. Beta blockers
B. Anticonvulsants
C. Avoiding factors that precipitate these headaches (e.g alcohol)
D. NSAID
E. Tricyclic antidepressants
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  #2  
Old 07-20-2011
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cluster headaches. Initial Tx is 100% O2, but it's not an option here, so i'd go for d) NSAID's
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  #3  
Old 07-21-2011
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F. None of the above

The initial management of cluster headaches involves administering 100% oxygen and preferably a triptan. Other options include ergotamine or steroids.
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  #4  
Old 07-21-2011
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Acute cluster headache--> oxygen or triptan
Prevention--> verapamil
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Old 07-21-2011
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yes, they are the absolute correct answer but NSAID's can also be used to abort the headache.
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Old 07-21-2011
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From the given options, D
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Old 07-21-2011
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Quote:
Originally Posted by podebrad View Post
From the given options, D
Hmm...Nsaids dont work at all...atleast not normal nsaids for cluster headache...you can only abort with 100% O2 and sumatriptan, lithium and prednisone too.. you can use CCB and lithium as prophylaxis but its not recommended unless you know the regualr cycle of these headache....
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  #8  
Old 07-21-2011
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Quote:
Originally Posted by Kais_MD View Post
Hmm...Nsaids dont work at all...atleast not normal nsaids for cluster headache...you can only abort with 100% O2 and sumatriptan, lithium and prednisone too.. you can use CCB and lithium as prophylaxis but its not recommended unless you know the regualr cycle of these headache....
then what would be your answer among the given options as there is no "none of the above"? I answered D because i heard fischer saying NSAID's too can be used in his neurology lectures video.
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Old 07-21-2011
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@aksyonez

Can u plz tell us the source of this qs?
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  #10  
Old 07-21-2011
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Quote:
Originally Posted by cool_atomic View Post
then what would be your answer among the given options as there is no "none of the above"? I answered D because i heard fischer saying NSAID's too can be used in his neurology lectures video.
Normal nsaids dont work..only a special few formulations that have sumatriptan & naproxen to alleviate the pain...i wonder if he means management as in now or chronic..>If its now nsaids but i think the question asks about a longterm mgmt which is avoid habits that cause clusters like smoking and alcohol<<<those are considered a maybe causes by fischer...
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Old 07-21-2011
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C it is...
no med for prevention...avoid triggers like alcohol
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Old 07-21-2011
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c..........avoid exposure to precipitating factor...
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  #13  
Old 07-21-2011
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A. Beta blockers
__________________
I'm Predictable In The Unpredictable Future !
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  #14  
Old 07-22-2011
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Tell us the answer AKSYONEZ .....we are waiting....:sorry:
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  #15  
Old 07-22-2011
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think its c
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  #16  
Old 07-22-2011
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cluster headache mx is (lith-100%o2 -ergot )
so non of the above is true
B. Anticonvulsants (valoporic acid for maintenance mx

Last edited by USMLE-Syndrome; 07-22-2011 at 08:10 AM.
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  #17  
Old 07-22-2011
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The crorrect answer is C. This patient is suffering from cluster headaches. treatment is primarly focused on avoiding factors that exacerbate these headaches, particularly alcohol, strenous exercise. This should be the FIRST step in management BEFORE pharamcotherapy is initiated. If therapy is indicated, patients will typically require both prophylactic and abortive therapy for releif of their symptoms. Abortive therapy includes O2, and the use of triptans. Prophylactic therapy includes prednisone, lithium,calcium channel blockers.
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  #18  
Old 07-22-2011
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Quote:
Originally Posted by aksyonez View Post
The crorrect answer is C. This patient is suffering from cluster headaches. treatment is primarly focused on avoiding factors that exacerbate these headaches, particularly alcohol, strenous exercise. This should be the FIRST step in management BEFORE pharamcotherapy is initiated. If therapy is indicated, patients will typically require both prophylactic and abortive therapy for releif of their symptoms. Abortive therapy includes O2, and the use of triptans. Prophylactic therapy includes prednisone, lithium,calcium channel blockers.
Did u make up this question urself?

I think there's a difference between factors "precipitating" a headache(trigger) and factors that "exacerbate" the headache(make it worse). In the actual qs, choice C says 'Avoiding factors that precipitate these headaches (e.g alcohol)'. Once the headache has been precipitated already,the next step shud be to use abortive therapy.
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  #19  
Old 07-23-2011
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I did not make this question up. It was in this step 2 ck book i have. That was the answer
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