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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Cluster headache, WBRKeyword::Lacrimation, WBRKeyword::Oxygen therapy, WBRKeyword::Headache, WBRKeyword::Headaches |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |