SBA

Question 1

A 45-year-old male presents to the emergency department at 3am with a severe unilateral headache. He describes the pain as being ‘unbearable’ and located behind his right eye. On examination, his right eye is red and watery, with a small pupil, and the patient is noticeably agitated. On further questioning, he states that this has been happening each night for several weeks.

Which drug can be used long-term to prevent these headaches from occurring?

A. Sumatriptan
B. Verapamil
C. Propranolol
D. Sertraline
E. Paracetamol

Answer 1

Verapamil. This is a cluster headache.

Question 2

27 year old female who is right-handed presents with a non-settling headache for about 3 months. The headache was described to be a dull aching pain, bilateral, generalised. The patient also complains to feel tired and exhausted, she feels more tired as the day goes by. She has been having headache frequently in the past years and her GP prescribed her multiple analgesics. She thinks that the headache is due to the Chiari malformation.

PMH: Postural tachycardia, Arrhythmia, Previous DVT, Anxiety, Depression, Ehlers-Danlos, Chiari malformation

DH: Vit B12 (Previously), Paracetamol, Gabapentin, Morphine, Mefenamic acid, Ivabradine, Cyclizine. Allergic to penicillin (Causes her to be nauseous)

SH: Lives with husband, currently unemployed, non-smoker, drink alcohol occasionally.

FH: Non-significant

A: Migraine
B: Cluster headache
C: Medication overuse headache
D: Tension headache 
E: Brain cancer

Answer 2

Medication overuse headache