343.A 35-year-old woman presents to the ED complaining of headache
and blurry vision. She has had daily headaches for 3 months associated
with blurry vision. She is afebrile, not losing weight, and has a normal neu-
rologic examination, including fundoscopy. You ask when her last menstrual
period was and she states she has not menstruated for 5 months and is not
taking oral contraceptive pills. She also complains of galactorrhea. Noncon-
trast head CT is normal. An LP is performed and reveals a normal opening
pressure. Which of the following is the most appropriate next step in man-
aging the patient’s headaches?
a. Repeat head CT with administration of IV contrast.
b. Initiation of therapy with bromocriptine.
c. Evaluation of CSF for xanthochromia and RBCs.
d. Treatment of her headache with analgesia and a MRI.
e. Repeat LP with removal of 15-mL CSF for therapeutic benefit.
344.A 37-year-old woman with a history of migraines presents to the ED
complaining of crampy lower abdominal pain for 3 days. Workup reveals
an intrauterine pregnancy and early prenatal care is arranged with obstet-
rics as an outpatient. You are concerned because her headaches are con-
trolled with a significant number of medications. She uses medications for
both abortive therapy and for prophylaxis. Which of the following classes
of medications do you advise she discontinue while pregnant?
a. Anticonvulsants
b. β-Blockers
c. Triptans
d. Acetaminophen
e. Antiemetics
356 Emergency Medicine