Question of the Week # 267

267 )  A 32 year old woman is evaluated in your office for increasing headaches over the past few months. She has a 5 year history of intermittent headaches. The headaches are throbbing in nature and are localized to frontal area. They are often accompanied by nausea and vomiting. Her episodes are usually preceded by irritability and food craving. She usually takes ibuprofen at the onset of headache which seem to relieve her pain. She recently broke up with her partner and has been under severe emotional stress since then. Lately, her headaches have become more frequent occurring about 4 to 5 times per month. The episodes interfere with her quality of life. She denies any headache at this time.  Physical examination including neurological and ophthalmoscopic exam is normal.  Her last menstrual period was 16 weeks ago and a urine pregnancy test returns positive. Which of the following strategies is most appropriate for this patient?

A) Biofeedback

B) Lumbar puncture

C) Start Propranolol

D) Start Sumatriptan

E) Start Valproic acid

7 Responses

  1. bio feedback

  2. Biofeedback

  3. C
    this is recurrent headache she needs prophylaxis
    propranolol used as prophylaxis in pregnancy
    acetaminophen with or without codaine and biofeedback works on acute attack

  4. i dont know.y propanolol?

  5. propranolol y?

  6. A……..To prevent headaches during pregnancy:
    Avoid headache triggers. Keep track of your meals, activities and headaches for several days to help pinpoint your headache triggers — then do your best to avoid your triggers.
    Include physical activity in your daily routine. Try a daily walk or other gentle aerobic exercise.
    Practice relaxation exercises. Calming activities such as deep breathing, yoga and visualization can help keep headaches at bay.
    Eat smaller, more frequent meals throughout the day. This can keep your blood sugar on an even keel, which may help prevent headaches.
    Drink plenty of fluids. Staying hydrated can keep you feeling your best.
    Keep a regular sleep schedule. Fatigue and lack of sleep can contribute to headaches during pregnancy. Go to bed and wake up at about the same time every day, even on weekends.
    Maintain good posture. Poor posture or muscle tension can result in headaches, especially as you gain weight to support your pregnancy.
    Consider biofeedback. With this mind-body technique, you learn to control certain bodily functions — such as muscle tension, heart rate and blood pressure — to prevent headaches or reduce headache pain. If you’d like to try biofeedback, ask your health care provider for a referral to a biofeedback therapist.

    When a headache strikes:
    Rest. Lie down in a dark, quiet room with your eyes closed.
    Use a compress. Apply a warm compress (such as a hot towel) to your face, eyes and temples — or try a cold compress on the back of your neck.
    Try massage. Ask someone to massage your shoulders and neck to relieve tension. Rubbing your temples also may help.

    If these steps don’t help, check with your health care provider about other treatment options — especially if the headache is the worst you’ve ever had or the headache is accompanied by changes in vision.

    Remember, medication isn’t necessarily off-limits during pregnancy. Although aspirin, ibuprofen (Advil, Motrin, others) and many prescription migraine drugs aren’t recommended during pregnancy, most pregnant women can safely take acetaminophen (Tylenol, others) to treat occasional headaches. Your health care provider may recommend other medications as well. As with any medication, though, make sure you have the OK from your health care provider first.

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