CASE STUDY No.

1
THE POLYDRUG OVERDOSE

MEDICAL TERMS

▪ Narcotic abuse
》 Narcotic abuse is when you continue to use narcotics even though they are hurting you or others
▪ Narcotic
》 are medicines used to decrease or take away severe pain.
▪ Comatose
》 of or in a state of deep unconsciousness for a prolonged or indefinite period, especially as a result of
severe injury or illness.
▪ Overdose
》 an excessive and dangerous dose of a drug.
▪ Hypoventilating
》is breathing that is too shallow or too slow to meet the needs of the body. If a person hypoventilates,
the body's carbon dioxide level rises. This causes a buildup of acid and too little oxygen in the blood.
▪ Miotic
》Excessive constriction of the pupil of the eye, as a result of drugs, disease, or the like.
▪ Pupils
》is a hole located in the center of the iris of the eye that allows light to strike the retina.
▪ Airway
》The path that air follows to get into and out of the lungs. The mouth and nose are the normal entry
and exit ports for the airway.
▪ Oxygenated
》Supplied, treated, or enriched with oxygen.
▪ Cyanotic
》 Defined as a bluish discoloration, especially of the skin and mucous membranes, due to excessive
concentration of deoxyhemoglobin in the blood caused by deoxygenation.
▪ Vital signs
》 Clinical measurements, specifically pulse rate, temperature, respiration rate, and blood pressure, that
indicate the state of a patient's essential body functions.
▪ Blood pressure
》 The pressure of the blood in the circulatory system, often measured for diagnosis since it is closely
related to the force and rate of the heartbeat and the diameter and elasticity of the arterial walls.
▪ Temperature
》 is a measure of how hot or cold something is; specifically, a measure of the average kinetic energy of
the particles in an object, which is a type of energy associated with motion.
▪ Pulse
》 is a rhythmical throbbing of the arteries as blood is propelled through them, typically as felt in the
wrists or neck.
▪ Respiratory rate
》 The number of breaths per minute or, more formally, the number of movements indicative of
inspiration and expiration per unit time.
▪ Painful stimuli
》 is a technique used by medical personnel for assessing the consciousness level of a person who is not
responding to normal interaction, voice commands or gentle physical stimuli (such as shaking of the
shoulders).
▪ Mydriatic
》 is an agent that induces dilation of the pupil.
▪ Groin
》 The area between the abdomen and the thigh on either side of the body.
▪ Arms
》 Each of the two upper limbs of the human body from the shoulder to the hand.
▪ Abscess
》 A swollen area within body tissue, containing an accumulation of pus.
▪ Urination
》The discharge of urine from the body.
▪ Defecation
》 The discharge of feces from the body.
▪ Dilated
》 The process of enlargement, stretching, or expansion.
MEDICATION

Intravenous Naloxone HCl

▪ BRAND NAME
》 Narcan and Evzio

▪ GENERIC NAME
》 Naloxone

▪ MECHANISM OF ACTION
》NARCAN (naloxone) is not fully understood, in vitro evidence suggests that NARCAN (naloxone)
antagonizes opioid effects by competing for the µ, κ and σ opiate receptor sites in the CNS, with the
greatest affinity for the µ receptor.

▪ DRUG INTERACTION
》Any drugs in the opioid family, including codeine; Zohydro (hydrocodone); Abstral, Actiq, Duragesic,
Fentora, methadone, Demerol, Lazanda, or Subsys (fentanyl); Dilaudid (hydromorphone); and Opana or
Opana ER (oxymorphone) Drugs that contain topiramate, like Topamax or Qsymia.

▪ ADVERSE DRUG REACTION

》 Nausea, vomiting, sweating, tachycardia, increased blood pressure, tremulousness, seizures,
ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest which may result in death.
INTERPRETATION

■ The patient to be hypoventilating, with miotic pupils (approximately 2mm). His airway was cleared,
and he was adequately oxygenated during transfer to the hospital.
》 Hypoventilation is breathing that is too shallow or too slow to meet the needs of the body.
The patient hypoventilates, the body's carbon dioxide level rises. This causes a buildup of acid and too
little oxygen in the blood. hypoventilation might feel sleepy. Constricted pupils (miosis) are less than
2mm. Dilated pupils (mydriasis) are more than 7mm. This means that in the correct setting, the pupils
measure less than 2mm or larger than 7mm. A patient in bright sunlight, with pupils that are 7mm could
be considered too large for the situation. His airway is in normal condition and For adequate tissue
oxygenation to occur, well-oxygenated blood must be circulated at a sufficient flow to meet the
patient's metabolic needs.

■ He was comatose and cyanotic.

》 The patient is in critical condition. During a coma, a person does not react to external stimuli and they
will not show normal reflex responses. Comatose patients do not have sleep-wake cycles. Reasons for a
coma include intoxication, nervous system disease, metabolic disease, infections, or a stroke. He also
has cyanosis which is seen in the tongue and lips and is due to desaturation of central arterial blood
resulting from cardiac and respiratory disorders associated with shunting of deoxygenated venous blood
into the systemic circulation. Patients who are centrally cyanosed will usually also be peripherally
cyanosed.

■ His vital signs included blood pressure 120/60mmHg, temperature 96.6 oF, pulse 80/minute, and
respiratory rate 2/minute.

A. Blood Pressure:120/60 = NORMAL BP

classification Systolic Blood Pressure Diastolic Blood Pressure
(mmHg) (mmHg)
Normal <120 <80
Pre hypertension 120-139 80-89
Stage 1 hypertension 140-159 90-99
Stage 2 hypertension ≥160 ≥100

B. Temperature 96.6 o F ( 35.88°C) = BELOW THAN NORMAL BODY TEMPERATURE

Normal oral body Temperature: 37.5 degree Celsius
Fever: 38 degree Celsius

C. Pulse 80 per minute = NORMAL PULSE RATE

Normal pulse rate for adults: 72-80 beats per minute
Tachycardia: 100 beats per minute
Bradycardia: 60 beats per minute

D. Respiratory Rate 2/min = BELOW NORMAL RR

Normal respiratory rate: 12-20 breaths/min
Bradypnea/slow rr: <12 breaths/min
Tachypnea: >20 breaths/min

■ He did not respond to verbal commands or painful stimuli. His pupils were mydriatic (10mm).
》 One particular situation is when a painful stimulus is applied to an extremity to elicit a response, if
the patient does not respond to verbal stimuli. There are two different anatomic locations where a
painful stimulus is applied: centrally and peripherally. The patient pupil is dilated which causes by using
drugs such as cocaine, ecstasy, hallucinogenics, and crystal methamphetamine can lead to mydriasis.
Hallucinogenic drugs, such as LSD, affect the serotonin receptors in the brain, which can lead to dilation.
Stimulants such as cocaine increase levels of serotonin and cause similar effects on the eyes

■ His arms were scarred with venous tracks and healed abscesses.
》 The patient has scars with track marks which is, areas of discoloration along a vein which was
damaged due to injecting drugs intravenously. This is often noticeable along the forearms, where visible
veins are present, although they can be anywhere on the body that has been used as an injection site.
His abscesses is already healed.
QUESTIONS FOR RESEARCH:
1. Is this a case of narcoti sm? What drugs are classifi ed as narcoti cs?
》 Yes.
▪ The Big List of Narcoti c Drugs
》 Commonly Abused Narcotics & Opioids.
Opium
Heroin
Oxycodone (OxyContin, Roxicodone, and Percocet)
Hydrocodone (Vicodin, Norco, Lortab)
Morphine (MS Contin and Kadian)
Hydromorphone (Dilaudid and Exalgo)
Fentanyl (Actiq, Fentora, Duragesic, Subsys, Abstral, and Lazanda)

2. How much Narcan should be used? Are there alternati ves to Narcan? What routes
should be used?
》 Usage in Adults. Opioid Overdose-Known or Suspected: An initial dose of 0.4 mg to 2 mg of NARCAN
(naloxone) may be administered intravenously. If the desired degree of counteraction and improvement
in respiratory functions are not obtained, it may be repeated at two- to three-minute intervals.
》 Alternati ves to Narcan
Other options besides Narcan are available to treat opioid overdose. Some may be a better fit for you
than others. If you're interested in finding an alternative to Narcan, talk with your doctor. They can tell
you about other treatments that may work well for you.
Other forms of naloxone (the active drug in Narcan) may be used to reverse an opioid overdose. These
include injectable forms of naloxone, which can be injected in one of these three ways:
into your muscle (called intramuscular)
into your vein (called intravenous, or IV)
under your skin (called subcutaneous)
Injectable forms of naloxone are mostly used in a healthcare facility, such as a hospital.
》 Alternate routes of naloxone administration include intraosseusly, intramuscularly, intranasally, or
via endotracheal tube. Recommending these routes for routine use in an uncomplicated overdose is
difficult because primary attention should be focused on airway maintenance.

3. How frequently is Narcan indicated as a therapeuti c measure?

》 0.4 to 2 mg IV, IM, or subcutaneously, up to a total dose of 10 mg; doses may be repeated every 2 to
3 minutes, as needed. In emergency settings, clinical practice guidelines recommend 0.4 to 2 mg IV;
alternatively, 0.4 to 0.8 mg may be given by IM or subcutaneous injection if systemic perfusion is
adequate.

4. What do narcoti c abusers use besides narcoti cs?

》 Marijuana
Marijuana (cannabis) refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or
Cannabis indica plant and is the most commonly used illicit substance. It is now legal in some states for
medical and recreational use. Some people use marijuana for its pleasurable high, but this drug also
impairs short-term memory and learning, the ability to focus, and coordination. It also increases heart
rate, can harm the lungs, and can increase the risk of psychosis in vulnerable people. Data suggest that
30 percent of those who use marijuana may have some degree of marijuana use disorder.7 People who
begin using marijuana before the age of 18 are four to seven times more likely than adults to develop a
marijuana use disorder.

5. What blood specimens must be drawn, and what further therapeuti c measures are
indicated?
》 A toxicology test (drug test or “tox screen”) looks for traces of drugs in your blood,
urine, hair, sweat, or saliva. You may need to be tested because of a policy where you
work or go to school. Your doctor could also order a toxicology test to help you get
treatment for substance abuse or keep your recovery on track. is intended to help
addicted individuals stop compulsive drug seeking and use. Treatment can occur in a
variety of setti ngs, take many diff erent forms, and last for diff erent lengths of ti me.
Because drug addicti on is typically a chronic disorder characterized by occasional
relapses, a short-term, one-ti me treatment is usually not suffi cient. For many, treatment
is a long-term process that involves multi ple interventi ons and regular monitoring.There
are a variety of evidence-based approaches to treati ng addicti on. Drug treatment can
include behavioral therapy (such as cogniti ve-behavioral therapy or conti ngency
management), medicati ons, or their combinati on. The specifi c type of treatment or
combinati on of treatments will vary depending on the pati ent’s individual needs and,
oft en, on the types of drugs they use.

6.What other reasons could there be for persistent coma and mydriasis in this pati ent ?
》 Opioid overdose occurs when a person has excessive unopposed sti mulati on of the
opiate pathway. This can lead to decreased respiratory eff ort and possibly death. The
frequency of opioid overdose is rapidly increasing. Drug overdose is the leading cause of
accidental death.When the pati ent increases the dose or durati on of opioids, then
toxicity is a potenti al complicati on.

7. Who might be expected to present with a narcoti c overdose?

medical expertise to see thepatient as soon as possible, so if no EMS or other trained personnelare on
the scene, dial 911 immediately. All you have to say is:“Someone is not breathing.” Be sure to give a
clear address and/ordescription of your location.7

8. What are the hallmarks of opiate withdrawal?

》 These drugs can cause physical dependence. This means that a person relies on the
drug to prevent withdrawal symptoms. Over ti me, more of the drug is needed for the
same eff ect. This is called drug tolerance.
How long it takes to become physically dependent varies with each person.
When the person stops taking the drugs, the body needs ti me to recover. This causes
withdrawal symptoms. Withdrawal from opiates can occur any ti me long-term use is
stopped or cut back.
 CHECK FOR SIGNS OF
OPIOID OVERDOSE

9.Outline the specifications from the caseSUPPORT

studyto satisfy
THE the steps in the general
managementofpoisoning. PERSON’S
BREATHING

ADMINISTER
NALOXONE
⬇
MONITORTHE
PERSON’S RESPONSE]

⬇
 CASE STUDY No. 2
A HEALTHY HEADACHE

MEDICAL TERMS AND ABBREVIATIONS

▪ Headaches
》can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine
or high blood pressure, anxiety, or depression. It can lead to other problems.
▪ Double vision
》 occurs when a person sees a double image where there should only be one. The two images can be
side by side, on top of one another, or both. The condition can affect balance, movement, and reading
ability. If double vision affects just one eye, it is monocular. If it affects both eyes, it is binocular.
▪ Psychiatric
》 the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders.
▪ Diplopia
》is the simultaneous perception of two images of a single object that may be displaced horizontally,
vertically, diagonally (i.e., both vertically and horizontally), or rotationally in relation to each other.
▪ Anorexia
》lack or loss of appetite for food (as a medical condition).
an emotional disorder characterized by an obsessive desire to lose weight by refusing to eat.
▪Arthralgias
》 defined as any discomfort or pain in the joints (joint pain).
▪ Muscular stiffness
》 is when your muscles feel tight and you find it more difficult to move than you usually do, especially
after rest. You may also have muscle pains, cramping, and discomfort.
▪ soreness
》 pain in a part of one's body.
▪ Menstrual irregularities
》 are problems with a girl's normal monthly period. For example, girls may miss periods, have them too
frequently, have painful periods, or have excessively heavy flow. Menstrual irregularities can sometimes
be a sign of an underlying health issue.
▪ Thyroid dysfunction
》disorders can range from a small, harmless goiter (enlarged gland) that needs no treatment to life-
threatening cancer. The most common thyroid problems involve abnormal production of thyroid
hormones. Too much thyroid hormone results in a condition known as hyperthyroidism.
▪ Symptom
》 a physical or mental feature which is regarded as indicating a condition of disease, particularly such a
feature that is apparent to the patient.
▪ Viral syndrome
》A viral illness may cause a number of symptoms such as fever. Other symptoms depend on the part of
the body that the virus affects.
▪ Head trauma
is any trauma to the scalp, skull, or brain. The injury may be only a minor bump on the skull or a serious
brain injury.
▪ Toxins
》an antigenic poison or venom of plant or animal origin, especially one produced by or derived from
microorganisms and causing disease when present at low concentration in the body.
▪ Physical examination
》 is a routine test your primary care provider (PCP) performs to check your overall health.
▪ Well nourished
》 having been provided with plenty of the material necessary for life and growth.
▪ Acute distress
》 is characterized by the development of severe anxiety, dissociation, and other symptoms that occurs
within one month after exposure to an extreme traumatic stressor
》is usually described as having five layers, which can conveniently be remembered as a mnemonic.
▪ Blood pressure
》 The pressure of the blood in the circulatory system, often measured for diagnosis since it is closely
related to the force and rate of the heartbeat and the diameter and elasticity of the arterial walls.
▪ Temperature
》 is a measure of how hot or cold something is; specifically, a measure of the average kinetic energy of
the particles in an object, which is a type of energy associated with motion.
▪ Pulse
》 is a rhythmical throbbing of the arteries as blood is propelled through them, typically as felt in the
wrists or neck.
▪ Respiratory rate
》 The number of breaths per minute or, more formally, the number of movements indicative of
inspiration and expiration per unit time.
▪ Alopecia
》also known as spot baldness, is a condition in which hair is lost from some or all areas of the body.
Often it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress may
result. People are generally otherwise healthy.
▪ Pubic
》relating to the pubes or pubis
▪ Auxillary hair
》 uncountable, plural axillary hairs) (uncountable) Androgenic hair growing in the armpit, normally
beginning at the onset of, or shortly after, pubarche. (countable) A single strand of axillary hair.
▪ Scant
》 to provide an incomplete supply of
▪ Acne vulgaris
》is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and
inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland).
▪ Fissures
》 a small tear in the thin, moist tissue (mucosa) that lines the anus.
▪ Nontender
》 Not tender; said of body parts or lesions that do not trigger discomfort upon palpation.
▪splenomegaly
》 is a condition that occurs when your spleen becomes enlarged.
▪ Cranial nerve palsies
》 Strabismus or misalignment of the eyes, can be caused by palsies or weakness of certain cranial
nerves (CN).
▪ Spontaneous venous pulsations
》 is a result of the variation in the pressure gradient along the retinal vein as it traverses the lamina
cribrosa.
▪ Glucose
》 is the main type of sugar in the blood and is the major source of energy for the body's cells.
▪ Protein
》is a macronutrient that is essential to building muscle mass.
▪ Electrolytes
》a liquid or gel that contains ions and can be decomposed by electrolysis.
▪ Liver function test
》 also referred to as a hepatic panel, are groups of blood tests that provide information about the
state of a patient's liver. These tests include prothrombin time (PT/INR), activated Partial
Thromboplastin Time (aPTT), albumin, bilirubin (direct and indirect), and others.
▪ X – rays
》 are a type of radiation called electromagnetic waves. X-ray imaging creates pictures of the inside of
your body. The images show the parts of your body in different shades of black and white. This is
because different tissues absorb different amounts of radiation.
▪ Spine
》 a series of vertebrae extending from the skull to the small of the back, enclosing the spinal cord and
providing support for the thorax and abdomen; the backbone.
▪ Skull
》 the skeletal structure of the head that supports the face and protects the brain. It is subdivided into
the facial bones and the brain case, or cranial vault.
▪ Lumbar puncture
》 also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal,
most commonly to collect cerebrospinal fluid for diagnostic testing.
▪ Spinal fluid
》 is a clear, colorless liquid that surrounds and protects the CNS. It bathes the brain and spine in
nutrients and eliminates waste products. It also cushions them to help prevent injury in the event of
trauma.
▪ CBC ( complete blood count)
》 is a blood test used to evaluate your overall health and detect a wide range of disorders, including
anemia, infection and leukemia.
▪ BUN (blood urea nitrogen)
》 test measures the amount of nitrogen in your blood that comes from the waste product urea. Urea is
made when protein is broken down in your body. Urea is made in the liver and passed out of your body
in the urine. A BUN test is done to see how well your kidneys are working.
INTERPRETATION:

▪ Physical examination revealed a slender, well nourished young woman in no acute distress.
Temperature, pulse respiratory rate, and blood pressure were within normal limits.
》The patient is strong and healthy. Her temperature, pulse respiratory rate, and blood pressure are
normal.

▪ Her scalp hair was coarse, with mild alopecia. Pubic and auxillary hair was scant.
》 Her hair texture has the widest and largest circumference of any other. Unlike thin or medium hair,
coarse hair contains all three layers of the hair shaft — cortex, cuticle, and medulla. If the hair strand is
thicker than the thread, you have coarse hair and She experience hair loss. A mild case of alopecia
areata starts with one to two coin-size hairless patches. In many instances, it stops after that.
Sometimes, the hair will grow back. She's losing large amounts of pubic and auxillary hair and you don’t
think it’s attributable to aging, it could be the symptom of a serious condition. Because of Hormonal
changes. Hormones are chemical messengers that control many functions in the body, including hair
growth. During puberty, an increase in hormones called androgens triggers the growth of pubic hair. As
a person ages, their body begins to produce fewer androgens. This may result in pubic hair loss. The
reason of auxillary hair is the evolutionary significance of human underarm hair is still debated. It may
naturally wick sweat or other moisture away from the skin, aiding ventilation. Colonization by odor-
producing bacteria is thereby transferred away from the skin (see skin flora).

▪ Her skin was dry, and there was superficial facial acne vulgaris. Her lips were scaled and cracked, and
there were small fissures at the corners of her mouth.
The skin of patient was dry. Dry skin is usually harmless. But when it's not cared for, dry skin may lead
to:
•Atopic dermatitis (eczema)
- If you're prone to develop this condition, excessive dryness can lead to activation of the disease,
causing redness, cracking and inflammation.
•Infections
- Dry skin may crack, allowing bacteria to enter, causing infections.
》 Also she has superficial acne vulgaris which is the formation of comedones, papules, pustules,
nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles
and their accompanying sebaceous gland). Acne develops on the face and upper trunk. It most often
affects adolescents.

▪ Her heart and lungs were unremarkable.

》 Her heart and lungs is normal.
▪ Her liver extended 3cm below the right costal margin and was smooth and nontender.
》 In normal patients, the edge of the liver may be palpable just below the costal margin. It is soft and
smooth and may be slightly tender.

▪ There was no splenomegaly.

》 There is no enlarged spleen.
》 Normal

▪ Pressure on the long bones elicited moderately severe pain. No other musculoskeletal abnormalities
were noted.
》 The patient experienced bone pain.
Bone pain is extreme tenderness, aching, or other discomfort in one or more bones. It differs from
muscle and joint pain because it’s present whether you’re moving or not. The pain is commonly linked
to diseases that affect the normal function or structure of the bone.
》 What causes bone pain?
Many conditions and events can lead to bone pain;
Injury
Mineral deficiency
Metastatic cancer
Bone cancer
Infection
Leukemia
》 There is no musculoskeletal abnormalities were noted.

▪ Neurologic examination revealed minimal bilateral sixth nerve palsies, normal papillary responses,
and blurred and slightly elevated disk margins, with venous pulsations. There were no gross visual
field defects. There was no motor weakness and no sensory disturbance; there were no abnormal
reflexes, nor were there signs of meningeal irritation. Mental functions were normal to routine
testing.
》 The patient has Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction
of cranial nerve VI (the abducens nerve), which is responsible for causing contraction of the lateral
rectus muscle to abduct (i.e., turn out) the eye. ... The condition is commonly unilateral but can also
occur bilaterally.
Diplopia is the most common symptom. Patients will have horizontal uncrossed diplopia which is greater
at distance than at near. The diplopia is also worse in the direction of the palsied muscle and gets better
in the contralateral gaze (incomitant). In recent onset palsies, the deviation measures greater when the
paretic eye is fixating and smaller when the nonparetic eye is fixing (primary and secondary deviations).

Papilledema or papilloedema is optic disc swelling that is caused by increased intracranial pressure due
to any cause. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral
papilledema can suggest a disease in the eye itself, such as an optic nerve glioma. If the optic disc
appears elevated and has a blurred outside edge, your doctor can diagnose papilledema. The pressure
within the nerve can cause the draining veins in your eye to become congested. Papilledema due to
raised intracranial pressure is almost always bilateral.

》 Gross visual field defects: Normal

》 Motor weakness and sensory disturbance: Normal
》Abnormal reflexes: Normal ; No signs of meningeal irritation.
》Mental functions: Normal

QUESTION FOR RESEARCH:

In assessing the patient, the following questions should be raised at this time:
1. What are the important clues to the correct diagnosis?
》 The correct diagnosis of headache disorders in an emergency room is important for developing early
management strategies and determining optimal emergency room activities. This prospective clinical
based study was performed in order to determine demographic and clinical clues for differential
diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the
emergency room practitioners.

2. When and for whom should a lumbar puncture be performed?

》 Neurologists specialize in caring for people with diseases and conditions of the brain and nervous
system, including the spinal cord, nerves, muscles, and related blood vessels.

3. What are the causes of increased intracranial pressure?

》 This is the fluid that surrounds the brain and spinal cord. Increase in intracranial pressure
can also be due to a rise in pressure within the brain itself. This can be caused by a mass (such
as a tumor), bleeding into the brain or fluid around the brain, or swelling within the brain itself.

4. What distinctions can be made between the acute and chronic forms of
intoxication?
》 Acute intoxication. Intoxication is a transient condition that follows the administration of alcohol or a
psychoactive substance and results in disturbances in the level of consciousness, cognition, perception,
judgment, affect or behavior, or other psychophysiological functions and responses.
intoxication was categorized as acute (single toxic exposure), chronic (long-term toxic exposure),

5. Which confirmatory laboratory tests should be obtained, and what are the
potential pitfalls in their interpretation?
》 the patient has alcopecia, Sixth nerve palsy, or abducens nerve palsy and Papilledema or
papilloedema.

6. What therapy, if any is indicated? What is the natural course of the disease, and
are there any long-term sequelae to be expected?
》Treatment might include:
Rest in a quiet, dark room
Hot or cold compresses to your head or neck
Massage and small amounts of caffeine
Over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol,
others) and aspirin
Prescription medications including triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig)
Preventive medications such as metoprolol (Lopressor), propranolol (Innopran, Inderal, others),
amitriptyline, divalproex (Depakote), topiramate (Qudexy XR, Trokendi XR ,Topamax) or erenumab-aooe
(Aimovig)
》 Hemicrania continua, a one-sided headache that can feel like a migraine
•Primary stabbing headaches, which last for a few seconds and can occur several times throughout the
day
•Primary exertional headaches, caused by exercise
•Chronic paroxysmal hemicranias, sharp, one-sided headaches that can cause tearing or a congested
nose
•Medication overuse headaches, which occur from overusing pain medications for headaches for at
least three months. These headaches occur at least 15 days out of the month.
Other headache types include:
•Cluster headaches, which cause severe pain on one side of the head and occur off and on for weeks
over the course of a few months. Cluster headaches are associated with one or more signs and
symptoms, such as tearing, nasal congestion and nasal discharge. These occur on the same side as the
pain.