WBR0539

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Neurology
Prompt	[[Prompt::A 23-year-old man presents to the physician's office for recurrent episodes of excruciating headaches that occur at night. Upon further questioning, the patient reports his headache lasts for 30 minutes, is mostly prominent behind his left eye and associated with lacrimation and runny nose. He denies photophobia, nausea, or aura before the onset of his headache. Which of the following is the best first line treatment for this patient's symptoms?]]
Answer A	AnswerA::100% Oxygen
Answer A Explanation	AnswerAExp::100% Oxygen therapy is recommended for patients with cluster headache
Answer B	AnswerB::Sumatriptan
Answer B Explanation	[[AnswerBExp::Triptans are effective for cluster headaches. However, oxygen therapy is first started to relieve symptoms. Triptans may be used following oxygen therapy. To note, triptans have their drawbacks and are contraindicated in patients with coronary artery disease due to their vasoconstrictive side effects.]]
Answer C	AnswerC::Ibuprofen
Answer C Explanation	AnswerCExp::NSAIDS are also effective against cluster headache but oxygen therapy is best initiated first.
Answer D	AnswerD::Carbamazepine
Answer D Explanation	AnswerDExp::Carbamazepine can also be used for cluster headache. Nonetheless, oxygen therapy is best initiated first.
Answer E	AnswerE::Phenytoin
Answer E Explanation	AnswerEExp::Phenytoin has been used in cluster headache. Nonetheless, oxygen therapy is best initiated first.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Cluster headache is characterized by episodic unilateral headaches that often lasts for several months with periods of remission. Cluster headaches are best described as excruciating episodes of unilateral headaches in the peri-orbital region that last for 15 minutes up to 3 hours. They are associated with lacrimation, rhinorrhea, and nasal blockage. Cluster headaches usually occur at night and patients complain of restlessness and agitation during the episodes. The first line therapy for acute attacks of cluster headaches is inhalation of high-dose, high-flow oxygen at 100% for 15 minutes. Oxygen therapy is preferred over other drugs because of its rare side effects and its remarkable therapeutic effects in cluster headaches. Educational Objective: 100% oxygen therapy for 15 minutes is recommended to relieve symptoms of patients with cluster headaches. References: Cohen AS, Burns B, Goadsby PJ, et al. High-flow oxygen for treatment of cluster headache: A randomized trial. J Am Med Assoc. 2009;302(22):2451-2457.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Cluster headache, WBRKeyword::Lacrimation, WBRKeyword::Oxygen therapy, WBRKeyword::Headache, WBRKeyword::Headaches
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::