headache 2

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headache 2

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darkhorse
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11/09/07 - 07:25 PM

An 18-year-old college student comes to the ER with a headache which is holocephalic, steady, and unaccompanied by any other symptoms or findings. You give him a prescription of Fiorinal, (butalbital, aspirin and caffeine). He returns on a different shift 2 days later with continuing symptoms. The Fiorinal was slightly effective, bul,he thinks he took too much. He is slightly groggy, but there are no other findings. He has no history of drug use or chronic headaches. The physician prescribes a shot of Demerol hoping he can stop the headache so the student can study for his finals. When he returns 12 hours later, there is little change in his story or exam. He demands another shot

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mjl1717
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11/09/07 - 08:01 PM

Tension H.A.

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neuroblastoma
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11/09/07 - 08:06 PM

mjl1717 wrote:
Tension H.A.

thats wht i thought grin

.....big time in USMLE takers. sticking out tongue

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drdg
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11/10/07 - 08:12 AM

Kamsi
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11/10/07 - 11:12 AM

Chronic headache syndrome

darkhorse
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11/10/07 - 11:23 AM

This person could be drug seeking. Signs which may point to this are a family history of drug abuse or alcoholism. However, he could also have his first prolonged migraine. This would be unusual, but not unheard of even though it is not unilateral or throbbing. On the other hand, you are obligated at this point to work him up because he is presenting with "the First and the Worst" headache of his life. He should have a blood screen for infection and metabolic disease, a CT scan without contrast to look for blood, and an LP to look for blood and infection

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