QuestionSBA
QuestionChoice
These represent initial treatment options for cluster headaches.
10028429
d
Prescribe 100% oxygen and subcutaneous sumatriptan
QuestionChoice
This may be an option in flares of rheumatoid arthritis but this vignette does not describe any joint pain, making this less likely.
10028430
e
IV Methylprednisolone
QuestionChoice
This is correct. This scenario describes medication overuse headache, for which the treatment is to cease analgesics. Opiods should be tapered as opposed to stopped due to risk of withdrawal.
10028426
a
Gradually taper tramadol
QuestionChoice
The scenario does not describe a migraine and this treatment is unlikely to help with medication overuse.
10028428
c
Prescribe oral triptans + NSAID
QuestionChoice
This is likely to precipitate opioid withdrawal.
10028427
b
Immediately cease all analgesics
Concept
Chapter
2693
6061
Medication overuse headache
Topic
141
Neurology
18083
The treatment for medication overuse headache is to cease analgesics, with opioids being tapered gradually rather than stopped abruptly to reduce the risk of withdrawal symptoms.
A 60 year old woman complains of daily headaches. She has no associated scalp tenderness, photophobia, phonophobia, nasal discharge or eye watering.

Her past medical history includes rheumatoid arthritis for which she has recently been started on daily tramadol.

Which of the following is the most appropriate management plan?
a