Post-Quiz: MIGRAINE AND HEADACHES

A 19-year-old woman with a history of migraines comes to the ED complaining of a throbbing unilateral headache of an intensity of 8/10. She also exhibits photophobia and has had multiple non-bilious, non-bloody vomiting episodes over the past six hours. She is not currently taking any medications. Among the following, which is the most appropriate treatment for her vomiting?

A 37-year-old woman with a past medical history of diabetes mellitus, constipation, irritable bowel syndrome, and anxiety disorder, presents to the emergency department with the chief complaint of periodic episodes of intense facial pain that have started suddenly and resolved spontaneously within the past week. She describes the pain as being located on her face, particularly around her eye, severe enough to induce lacrimation. The patient admits to being apprehensive about appearing in public due to fear of an impending episode. On examination, her vitals are temperature 99.5°F (37.5°C), blood pressure 177/108 mmHg, pulse rate 90 beats/minute, respiratory rate 17 breaths/minute, and oxygen saturation 98% on room air. Physical examination reveals pain on palpating the face, while neurological examination shows that cranial nerves II through XII are intact, with both pupils equal in size and reactive to light.

A 36 year-old female with recurrent, severe occipital headaches has been diagnosed with occipital neuralgia. Her physician recommends a treatment approach involving Great Occipital Nerve Blockade (GONB) with corticosteroids using a long-acting local anesthetic. Which long-acting local anesthetic is typically preferred for this procedure?

KH, a 31-year-old male with a history of chronic migraines, presents to the emergency room with a severe migraine, despite taking two doses of sumatriptan (100mg per dose) at home. His nausea hasn’t led to vomiting, and he has no other significant past medical history. His vital signs and lab results are within normal limits. His clinician is considering a sphenopalatine ganglion (SPG) block procedure using topical lidocaine or bupivacaine to manage his persistent headache. Which of the following statements about the SPG block procedure is incorrect?

A 12-year-old child presents with frequent episodes of moderate headaches, lasting approximately 3 hours each time. The symptoms are typically centralized to the forehead and temples, occur once or twice a month, and are often associated with periods of stress at school. There are no accompanying symptoms such as nausea, vomiting, or photophobia. Which of the following is the most appropriate first-line treatment for this patient’s tension-type headaches?