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| * neuroq4 |
| | #531313 |
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A 51-year-old man is evaluated for migraine headache. He reports a history of migraines with onset at age 20 years. He had one or two headaches a month until about age 30, and since that time has only had headaches once every 3 to 4 years. When he was in his 20s he was usually treated with ergotamines with success. He has not used any treatment for the past 8 years because his headaches have been infrequent and not severe. Todays headache is on the left side of the head, maximal behind the left eye, with a pulsating quality. It is associated with a scotoma, and he feels nauseated.
His medical history includes gastroesophageal reflux disease, coronary artery disease, depression, and plantar fasciitis; he had a myocardial infarction 2 years ago. His medications include rabeprazole, atenolol, enteric coated aspirin, bupropion, and simvastatin.
What treatment would you recommend for this patient’s headache?
A. Sumatriptan intramuscularly
B. Sumatriptan orally
C. Caffeine/ergotamine orally
D. Naproxen and metoclopramide
E. Dihydroergotamine nasal spray
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| * Re:neuroq4 |
| #2189387 |
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so ergotamine and sumatriptan are contraindicated in CAD.
A 57-year-old man presents to your office with complaints of multiple episodes of severe, unilateral, periorbital headaches over the last two weeks, as well as right now. The patient states that these headaches last approximately one hour and usually occur at night. They wake him from sleep. Sometimes they are accompanied by nasal stuffiness and lacrimation. He denies nausea or vomiting. He noticed that occasional alcohol intake or emotional stress at work precipitates his headache. He tried a large dose of acetaminophen with no significant relief. The patient also complains of periodic episodes of squeezing chest pain after walking 4 to 5 blocks. There is no recent change in the character of the chest pain. His pulse is 72/min, and his blood pressure is 130/80 mm Hg. Physical examination reveals Horner's syndrome on the left side. Which of the following is the most appropriate management for his headache?
(A) Ibuprofen
(B) Prednisone
(C) Ergotamine
(D) Propranolol
(E) Sumatriptan |
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| * Re:neuroq4 |
| #2198349 |
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for the 58yr old man option b.
option a is used for valve pathology i guess.
please discuss |
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| * Re:neuroq4 |
| #2198350 |
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the 57 yr old has features of cluster headache ,and has risk factor of cad ...wonder why he has horners? |
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