aborting cluster headache in cardiac patient...Oxygen is not in options ! - USMLE Forums
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Old 06-25-2012
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Default aborting cluster headache in cardiac patient...Oxygen is not in options !

A 57-year-old man presents to your office with complaints of
multiple episodes of severe, unilateral, periorbital headaches
over the last two weeks, as well as right now. The patient states
that these headaches last approximately one hour and usually
occur at night. They wake him from sleep. Sometimes they are
accompanied by nasal stuffiness and lacrimation. He denies
nausea or vomiting. He noticed that occasional alcohol intake or
emotional stress at work precipitates his headache. He tried a
large dose of acetaminophen with no significant relief. The
patient also complains of periodic episodes of squeezing chest
pain after walking 4 to 5 blocks. There is no recent change in
the character of the chest pain. His pulse is 72/min, and his
blood pressure is 130/80 mm Hg. Physical examination reveals
Horner's syndrome on the left side. Which of the following is the
most appropriate management for his headache?
(A) Ibuprofen
(B) Prednisone
(C) Ergotamine
(D) Propranolol
(E) Sumatriptan
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Old 06-25-2012
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Ans E ............ looks like cluster Headache ....
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Old 06-25-2012
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B) Prednisone.

Could this be vasculitis?
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Old 06-25-2012
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It is cluster headache and you can see Horner's with CH at times.

The guy has HA now.

So you want to give him an abortive therapy as well as a prophylaxis. I think it is Ergotamine. C.
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Old 06-25-2012
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Correct Answer E. Sumitriptan

Best initial treatment: 100 % O2, seeing that not in the options, go for either ergot or sumitriptan.
Since he has symptoms suggestive of angina, ergot is contraindicated.
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Old 06-25-2012
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Quote:
Originally Posted by tyagee View Post
A 57-year-old man presents to your office with complaints of
multiple episodes of severe, unilateral, periorbital headaches
over the last two weeks, as well as right now. The patient states
that these headaches last approximately one hour and usually
occur at night. They wake him from sleep. Sometimes they are
accompanied by nasal stuffiness and lacrimation. He denies
nausea or vomiting. He noticed that occasional alcohol intake or
emotional stress at work precipitates his headache. He tried a
large dose of acetaminophen with no significant relief. The
patient also complains of periodic episodes of squeezing chest
pain after walking 4 to 5 blocks. There is no recent change in
the character of the chest pain. His pulse is 72/min, and his
blood pressure is 130/80 mm Hg. Physical examination reveals
Horner's syndrome on the left side. Which of the following is the
most appropriate management for his headache?
(A) Ibuprofen
(B) Prednisone
(C) Ergotamine
(D) Propranolol
(E) Sumatriptan
yup , thats true but patient has stable angina. that means we must avoid option C,E [ not good because it causes vasopasm]. ans given is B !!
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