huyniid
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A 65 yo F with 10yr Hx of migraine headache and aura presents to the ER because of worsening headache. She reports that the headache is becoming more frequent over the last month, and that she has morning stiffness in her shoulders and neck. She takes ibuprofen for her headache, but has never been on prophylaxis for the migraines. Vital signs are normal, Neurologic exam shows no focal abn. There is some diffuse tenderness to palpation during a head and neck exam, and mild restriction of neck movement due to stiffness.
Which of the following is the most appropriate step in management?
A. Change her medication to SUMATRIPTAN
B. Obtain CSF for analysis
C. Order ESR
D. Oder CT scan
E. Start migraine prophylaxis such as beta blockers
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| DrPak
Forum Elite
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I'd go with B --> rule out meningitis.
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| chemamr
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you should rule out SAH through a CSF +- CT scan.
Edited by chemamr on 03/05/07 - 11:26 AM
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| 92306
Forum Senior
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A. Change her medication to SUMATRIPTAN
for prophylaxis propranolol, timolol, amitrytaline, valproic acid can be used.
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| Aashi
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C. Order ESR
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| chemamr
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well, we have A, B, C, D. Only E wasn't chosen by anybody.
what's the answer?
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| huyniid
Forum Elite
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Answer is C. Order ESR to rule out giant cell arteritis, because this patient has headache with RED FLAG symptoms
How is your idea, Asahi?
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| Aashi
Forum Moderator
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Headache + stiffness( neck and shoulders)-->probably PMR, an association of PMR is seen with giant cell arteritis-->if the pt c/o of visual s/s-->give HIGH dose steroids first, if not do an ESR,which will be the BEST next step in the dx--->normal ESR essentially rules out both the conditions.
GL
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
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| chemamr
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yes, it's true, I didn't read well the question, you're right Aashi 
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