USMLE Forum Archives - USMLE Step 3 - Headache
Headache
drbipinsingh - 07-01-09 16:02
A 24-year-old woman is evaluated for a severe, pulsating headache located on the left side of the head. The headache began 2 hours ago, is 8/10 in severity, and is associated with photophobia and fatigue. She also has diffuse pain to the slightest touch of the skin on the left side of her face, which occurs commonly with her severe headaches. She has a headache two to three times monthly, lasting all day, and severe headaches three to four times yearly. She denies any aura or other warning of headache onset. Although her headaches have frequently responded to a combination of acetaminophen-isometheptene-dichloralphenazone and naproxen, her current episode is refractory to these agents, and she experienced emesis on her attempt at taking the naproxen. Her history is significant for two visits in the past year to a local urgent care clinic for severe headaches that were treated with sumatriptan and intravenous metoclopramide, respectively, with good relief of symptoms. She takes no other medications.
On physical examination, temperature is 36.6 °C (97.9 °F), and blood pressure is 147/93 mm Hg. The remainder of the examination is normal except for the presence of hyperalgia over the left cheek.
Which of the following is the most appropriate treatment for this patient?
drbipinsingh - 07-01-09 16:02
A 24-year-old woman is evaluated for a severe, pulsating headache located on the left side of the head. The headache began 2 hours ago, is 8/10 in severity, and is associated with photophobia and fatigue. She also has diffuse pain to the slightest touch of the skin on the left side of her face, which occurs commonly with her severe headaches. She has a headache two to three times monthly, lasting all day, and severe headaches three to four times yearly. She denies any aura or other warning of headache onset. Although her headaches have frequently responded to a combination of acetaminophen-isometheptene-dichloralphenazone and naproxen, her current episode is refractory to these agents, and she experienced emesis on her attempt at taking the naproxen. Her history is significant for two visits in the past year to a local urgent care clinic for severe headaches that were treated with sumatriptan and intravenous metoclopramide, respectively, with good relief of symptoms. She takes no other medications.
On physical examination, temperature is 36.6 °C (97.9 °F), and blood pressure is 147/93 mm Hg. The remainder of the examination is normal except for the presence of hyperalgia over the left cheek.
Which of the following is the most appropriate treatment for this patient?
The correct answer and explanation will be available after you answer.
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#19
Re: Headache babbu5508 - 08-31-10 12:06 My answer is: c.
She denies any aura or other warning of headache onset
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