A 20-year-old woman comes to the office complaining of a 3-year history of headaches.

Discussion in 'Plab 1 and 2 forum' started by Santosh Jadhav, Oct 25, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    A 20-year-old woman comes to the office complaining of a 3-year history of headaches. She describes them as a frontal, throbbing pain, which may be on either side of the head and is worse when she wakes up in the morning, though it does not wake her from sleep. She decided to come to the office today because the frequency of the headaches had been increasing over the past 6 months and for the last month she has had a headache every single day. She usually takes 650 mg of acetaminophen and 200 mg of ibuprofen every 4 hours during the day. These do provide some relief. She has no other symptoms. Physical and neurologic examination is completely normal. The next most appropriate step in managing this case is to

    A. perform a lumbar puncture
    B. prescribe amitriptyline
    C. prescribe sumatriptan
    D. slowly taper down both the acetaminophen and ibuprofen, prescribing a small supply of acetaminophen/butalbital/caffeine for emergencies and see her back in 2 weeks
    E. stop the acetaminophen and increase the dose of ibuprofen

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