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Headache 01

Topic: Adult

Created on Monday, June 9 2008 by jdmiles

Last modified on Monday, June 9 2008.

A 38 year-old woman presents to your office complaining of a 4 month history of persistent headache. She states the pain is always present but fluctuating in intensity, sometimes mild and at other times moderate. When the pain is at its worst, she experiences nasal congestion and edema of the ipsilateral eyelid.
The pain is always unilateral.
She is unable to identify any precipitating factors.
She occasionally experiences brief episodes of sharp stabbing pain in addition to the continuous headache.
She reports occasional but infrequent photophobia and phonophobia. She has tried several over-the-counter remedies without relief. She has not used any analgesics in the last 2 weeks.
Physical exam is unremarkable.
Of the following, which treatment is most likely to result in rapid and complete relief of her headache?

A) Propranolol

B) Ibuprofen

C) Almotriptan

D) Indomethacin

E) Acetaminophen, dichloralphenazone, and isometheptene

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This question was created on June 09, 2008 by jdmiles.
This question was last modified on June 09, 2008.

ANSWERS AND EXPLANATIONS

A) propranolol

This answer is incorrect.

Propranolol can be helpful in prophylactic treatment of migraine. However, this patient's history is most consistent with hemicrania continua, which is characterized by its responsiveness to indomethacin. Propranolol is less likely to resolve her headache. (See References)


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B) ibuprofen

This answer is incorrect.

This patient's history is most consistent with hemicrania continua, which is characterized by its responsiveness to indomethacin. The patient has tried other over-the-counter remedies without relief, so ibuprofen is less likely to resolve her headache. (See References)


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C) almotriptan

This answer is incorrect.

This patient's history is most consistent with hemicrania continua, which is characterized by its responsiveness to indomethacin. Almotriptan is less likely to resolve her headache. (See References)


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D) Indomethacin

This answer is correct.

The patient suffers from hemicrania continua. This form of headache is characterized by continuous pain which is strictly unilateral. Exacerbations of the pain occur, but no triggers can be identified. The exacerbations may be accompanied by autonomic symptoms, such as miosis, sweating, and lacrimation. Photophobia and phonophobia may occur in some patients. This type of headache is characterized by its rapid and complete relief to indomethacin. Indomethacin has the potential for serious cardiac side effects, so patients treated with it must be closely followed. (See References)


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E) acetaminophen, dichloralphenazone, and isometheptene

This answer is incorrect.

The combination of acetaminophen, dichloralphenazone, and isometheptene can be an effective treatment for migraine. However, this patient's history is most consistent with hemicrania continua, which is characterized by its responsiveness to indomethacin. Treatment with acetaminophen, dichloralphenazone, and isometheptene is less likely to resolve her headache. (See References)


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References:

1. edited by Stephen D. Silberstein, Richard B. Lipton and Donald J. Dalessio. . New York ; Oxford University Press, 2001. (ISBN:0195135180)	Advertising:
2. Dodick, D.W. (2004). "Indomethacin-responsive headache syndromes." Curr Pain Headache Rep, 8(1) 19-26. (PMID:14731379)


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adult
Headache 01
Question ID: 060908040
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 06/09/2008
Modified: 06/09/2008
Estimated Permutations: 25200