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Old 10-02-2012
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Arrow Gyrus Daily Questions; Internal Medicine #45

A 46-year-old man presents for evaluation of severe unilateral headache. He states that he has had episodes of intermittent headache for the past 3 years. He describes the headaches as a stabbing pain located near his right temple. They occur abruptly and last up to 3 h at a time, during which he feels incapacitated, rating the pain as a 10 out of 10. Most of the time, the headaches begin in the early morning hours. When they occur, he finds it impos-sible to sleep. He feels that rubbing his head improves the pain but has noticed no other factors that relieve the pain.
Specifically, he has had no improvement with acetamino-phen, naprosyn, or oxycodone. When the headaches oc-cur, he develops nasal congestion and tearing on the side of the pain. He believes the headaches occur in cycles. He will have the headaches almost daily for up to 2 weeks at a time, but then have no headaches at all for as long as 3 months. He has decided to seek medical advice because he is worried about the possibility of a brain tumor be-cause of the severity of the headaches. He takes no medi-cines regularly. His vital signs and physical examination are normal. What is the best approach to treatment of these headaches?


A. Fluticasone nasal spray and loratadine, 10 mg orally
B. Indomethacin, 25 mg three times daily
C. Oxygen at 1012 L/min by nasal ca
D. Sumatriptan, 50 mg orally, at the onset of an attack E. Surgical consultation for microvascular decompres-sion of the trigeminal nerve
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aknz (10-02-2012), kmbaby04 (11-24-2012), Vaiting (10-03-2012)



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Old 10-02-2012
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Answer C

He has cluster headache ,the pain is unilateral with nasal congestion and tearing.The pain occurs in clusters ,pain for 2 weeks then no symptoms for some time .
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Old 10-02-2012
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C. Oxygen at 1012 L/min by nasal ca
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Old 10-02-2012
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C. Oxygen at 1012 L/min by nasal ca
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Old 10-02-2012
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It's cluster headache
So Ans is (C)
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Old 10-02-2012
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i will go with C
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Default C

It's C , this pt has cluster headache
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Old 10-03-2012
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Thanks for the classic question - where are these coming from? Usmlerx or kaplan?

O2 is right plus, I believe SC sumatriptan for first line Rx of cluster headheache. Can anyone agree?
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