Headache 347324.A 22-year-old woman presents to the ED complaining of headache.
She states that while at home she experienced a headache that was associ-
ated with blurry vision in both eyes with a shimmering line in her vision.
She subsequently lost her vision and felt uncoordinated, followed by
increased pain at the base of her skull. Upon arrival in the ED, her vision
returned to normal. A head CT scan and an LP are both negative. She now
complains of a persistent, severe, pulsatile headache. She has had two similar
episodes in the past year with the headache refractory to over-the-counter
medications. Which of the following is likely to relieve her symptoms?
a. Diazepam
b. High flow oxygen
c. Sumatriptan
d. Acetaminophen
e. LP with removal of 15 cc cerebrospinal fluid (CSF)
325.A 25-year-old man presents to the ED complaining of headache for
2 days. He describes the pain as pulsatile and occipital. The patient had an
LP 3 days prior and was diagnosed with viral meningitis after 4 days of
symptoms. Noncontrast head CT at that time was normal. He improved
shortly thereafter with defervescence of his fever and resolution of his con-
stitutional and nuchal symptoms. He states that his new headache is different
than his previous in that it is exacerbated by standing or sitting upright and
is relieved by sitting down and is not associated with photophobia or neck
stiffness. The headache is not relieved by over-the-counter pain medica-
tions. He is afebrile and nontoxic appearing. Which of the following is
definitive therapy for this patient’s headache?
a. A 1-L bolus of intravenous (IV) normal saline
b. Treatment with standard pharmacologic agents for migraine
c. Treatment with meclizine
d. Consultation with anesthesia for a blood patch
e. Repeat LP to improve symptoms