WBR1078
| Author | PageAuthor::Chetan Lokhande |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | SubCategory::Head and Neck, SubCategory::Neurology |
| Prompt | [[Prompt::A 34-year-old man who works as a manager in a big pharmaceutical company comes to your office with a headache since 3 days. On enquiry the headache appears to be only on the right side. He also reports of having some tearing, redness and rhinorrhea. Patient claims he had a similar episode 3 months back where the doctor gave him Sumatriptan and oxygen via nasal cannula, which subsided the pain. The patient also says that he has 5 large cups of coffee everyday. What measures should be taken to prevent this headache?]] |
| Answer A | AnswerA::Propranolol |
| Answer A Explanation | AnswerAExp::Proranolol is used for the prophylaxis of migraine and not cluster headache. |
| Answer B | AnswerB::Verapamil |
| Answer B Explanation | AnswerBExp::Verapamil can prevent the attacks of cluster headache. It is widely used to prevent headaches . |
| Answer C | AnswerC::Home nasal oxygen |
| Answer C Explanation | AnswerCExp::100% nasal oxygen is the treatment of choice to abort an acute attack. It may be used alone or in conjunction with Sumatriptan to treat cluster headache. |
| Answer D | AnswerD::Cut down his coffee intake |
| Answer D Explanation | AnswerDExp::Cutting down coffee slowly may prevent a headache that usually occurs due to caffeine withdrawal. However it has not effect on cluster headache. |
| Answer E | AnswerE::Bright light therapy |
| Answer E Explanation | AnswerEExp::Bright light (including sunlight) may trigger cluster attacks . Hence , it may not be used as a measure to prevent cluster headache. |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::Since the patient has unilateral headache with tearing, redness and rhinorrhoea the diagnosis is 100% cluster headache. The treatment for an acute attack is Sumatriptan and oxygen via nasal cannula . However, cluster headache is prevented by using calcium channel blockers like verapamil, cyproheptadine, topiramate, valproate, lithium carbonate and amitriptyline . Educational Objective: |
| Approved | Approved::No |
| Keyword | WBRKeyword::CLuster |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |