Hi Doctors, I have a patient who has serious headache which last for 3-7 minutes. She is 16 yr old and currently no exams so I ruled out tension headache. No nausea, vomiting or photo phobia so ruled out migraine. Her psychologist prescribe her tricyclic antidepressants and nsaids despite her answers in negative to queries related to depression.o weight loss. No personal issues.
I m thinking of getting CT scan to rule out any mass occupying lesion. I want suggestion from Allopathic point of view.
Are the headaches occurring in the same area every time? Given their short length, and a normal neurological exam, I would be highly doubtful of a space occupying lesion on CT scan. Headaches caused by space-occupying lesions usually IMPROVE as the day progresses, due to the decrease in intracranial pressure in the skull as the patient spends time standing up. I agree that this does not sound like a tension headache, but would consider occipital neuralgia, associated neck spasm. In addition, would have the patient keep a "headache diary", noticing location, timing of headaches and any food or other-related triggers. Avoid or cut back on Nutrasweet containing beverages, MSG, chocolate, ripe cheeses. Sleep hygiene: get at least 7 hours of sleep if possible in a quiet, dark, room that is at a temperature that is comfortable for you. Drink at least 5 glasses of water a day. Have small meals frequently to balance blood sugar. Seek counseling if at all possible if there are stress related issues. Take a walk for at least 20 minutes a day
You can consider cluster headaches as part of the Ddx. They usually tend to go away after a while, though how long it takes cannot be predicted. You can give her oxygen, triptane injection/nasal spray during the episode and see if she improves.
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