[khanar]

A 35 year old female patient presented with history of repeated episodes of headaches. The attacks followed somewhat a cyclic pattern and occasionally accompanied by nausea. She has managed most of the episodes with acetaminophen but she noticed that the attacks are becoming more severe and she demands more appropriate treatment. Patient is no medication except oral contraceptive pills. Examination revealed a fully conscious and alert patient with no neurologic deficits and normal vitals signs. Red eyes were noticed which the patient attributed to lack of sleep recently. Which of the following medications is useful as a secondary prevention in this case?
A- Valproic acid
B- Acetazolamide
C- Methysergide
D- Lithium
E- Diazepam

 

[FSUSTC]

Its Lithium ....

 

[khanar]

Cluster Headache

Agree with FSUSTC
This is a case of cluster headache (red eyes, cyclic pattern, ...etc)
Lithium is used in these patients
The use OCP in this patient is a distractor, they want us to think of pseudotumor cerebri so that we then choose acetazolamide as the answer

 

[Doc-Yuvi]

i thought Methysergide is used as an effective prophylaxis for migraines, maybe im thinking this wrong, can someone explain??

 

[khanar]

i thought Methysergide is used as an effective prophylaxis for migraines, maybe im thinking this wrong, can someone explain??

This is not migraine. This is cluster headache which is a different diagnosis.
Moreover, Methysergide is no longer recommended in the treatment of migraine because of its serious retroperitoneal fibrosis.