Perhaps
Forum Elite
Topics: 61
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A previously healthy 16yo female comes to the physician because of a headache, nausea, and one episode of vomiting over the past 2 days. She has had a constant headache for 2 hours; she describes it as throbbing and located over the left eye. The symptoms are only partially relieved with ibuprofen therapy. There is no visual impairment. She has had intermittent headaches over the past year. Her menstrual period began 2 days ago. She is sexually active with one partner and uses condoms for contraception. Her temperature is 36.7°C (98°F), blood pressure is 114/70 mm Hg, pulse is 104/min, and respirations are 18/min. Neurologic examination shows no abnormalities. Which of the following is the most appropriate next step in management?
A) Testing for Neisseria gonorrhoeae
B) CT scan of the head
C) Administration of acetazolamide
D) Administration of sumatriptan
E) Lumbar puncture
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| frank100
Forum Guru
Topics: 48
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(d) rule out migrane. if head ache doesn´t improve, then do work up for meningitis
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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Hi, I picked D that when answering.
But now I am wondering if they should be B to rule out tumor?
Is it a routein to use smatriptan as a trial for headaches?
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| shumaila
Forum Elite
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d
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| humbty
Forum Elite
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She has headaches for a year. Thats a long time.
The description is also very typical for migraine headaches.
She has no focal neuro signs, no fever, no neck stiffness (if one of those is present investigations are needed).
So there is good reasoning for a trial of triptane. But in my opinion triptane is not a routine medication to see if a headache is migraine!! If any warning signs are present investigations are necessary
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| wyvern
Forum Guru
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D
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| juanma0
Forum Senior
Topics: 10
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I say B. She has worsening headaches which is a RED flag for something else going on. Intermittent headaches-------now with vomiting.
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| cbenitesch
Forum Senior
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Posts: 141
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I choose D) give sumatriptan. I think this is a a vascular headache why? She is previously healthy, is 16 y.o., female, has had ittermitent headaches, lasting of the headache, localized on the left eye area, and she began her menstrual period 2 days ago time of the onset of this case. I think she may have migraine! or cluster headache?.
Why not A) she has no sexual risk behavior and no physical findings.
Why not B) maybe if I think on an expansive process or something that elevates ICP, but the only vomit episode was not "explosive" and she has nausea!.
Why not C) if I do my best effort to use acetazolamide for this particular case with her clinical history, I can if we are at highlands!!, cause this drug can be used to treat symptons related with high altitude.
Why not E) you know when to perform an LP!!! and obviously this is not the appropriate case.
Regards
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| frank100
Forum Guru
Topics: 48
Posts: 586
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thank you, cbenitesch. great elimination "round".
and thank you again for the "highlands" fact.
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