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Old 12-13-2012
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Question Treatment of Headaches

A 58-year-old woman has been suffering from daily headaches for months. They are not associated with an aura, nausea, vomiting, or photophobia. They last for 6 hours per day and occur about half the month. Her medical history is significant only for arthritis, for which she has been taking high doses of nonsteroidal anti-inflammatory drugs and acetaminophen based analgesics daily for the past several months. She has been gradually escalating her analgesic dose to manage her condition. Her physical examination is within normal limits. Which of the following is most likely to be effective in preventing her daily headaches?

(A) Behavioral modification therapies
(B) Controlling her analgesic use
(C) Prophylactic treatment with β-blockers
(D) Treatment with selective serotonin reuptake inhibitors
(E) Treatment with tricyclic antidepressants
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ans B...........
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(A) Behavioral modification therapies
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Old 12-15-2012
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The correct answer is B.
The patient most likely suffers from chronic daily headaches induced by analgesic medication overuse (e.g., acetaminophen), also known as analgesic rebound headaches. They typically last at least 4 hours per day and occur 15 days per month and are seen most commonly in women in their fifties. The first step in prevention would be to withdraw the patient from the offending medication. If there is another underlying headache syndrome, this will then reveal itself. Another analgesic can be used instead, or the same one can be later reintroduced, but with the instruction to consume it less often and in lower doses.
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Old 12-15-2012
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Quote:
Originally Posted by heartbeat View Post
A 58-year-old woman has been suffering from daily headaches for months. They are not associated with an aura, nausea, vomiting, or photophobia. They last for 6 hours per day and occur about half the month. Her medical history is significant only for arthritis, for which she has been taking high doses of nonsteroidal anti-inflammatory drugs and acetaminophen based analgesics daily for the past several months. She has been gradually escalating her analgesic dose to manage her condition. Her physical examination is within normal limits. Which of the following is most likely to be effective in preventing her daily headaches?

(A) Behavioral modification therapies
(B) Controlling her analgesic use
(C) Prophylactic treatment with β-blockers
(D) Treatment with selective serotonin reuptake inhibitors
(E) Treatment with tricyclic antidepressants
B.. controlling her analgesic use. looks like an analgesic overuse headache.
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