WBR0539
| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 23-year-old male presents to the physician's office for severe episodes of excruciating headaches manifesting 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 headaches. |
| Answer B | AnswerB::Sumatriptan |
| Answer B Explanation | [[AnswerBExp::Triptans are effective for cluster headaches, but oxygen therapy is initiated first to relieve symptoms. Triptans may be used following oxygen therapy although they are not frequently administered to 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 frequently initiated first. |
| Answer D | AnswerD::Carbamazepine |
| Answer D Explanation | AnswerDExp::Carbamazepine can also be used for cluster headache, but oxygen therapy is frequently initiated first |
| Answer E | AnswerE::Phenytoin |
| Answer E Explanation | AnswerEExp::Phenytoin has been used in cluster headache, but oxygen therapy is frequently initiated first. |
| Right Answer | RightAnswer::A |
| Explanation | [[Explanation::Cluster headaches are characterized by episodic unilateral headaches, which often last for several months with periods of remission. Cluster headaches are best described as excruciating episodes of unilateral headaches in the peri-orbital region, lasting for 15 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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::cluster headache, WBRKeyword::lacrimation, WBRKeyword::rhinorrhea, WBRKeyword::nasal, WBRKeyword::optical, WBRKeyword::oxygen therapy, WBRKeyword::first line of treatment, WBRKeyword::headaches |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |