SAQ 277 – Neurology – sudden severe headache and acute migraine treatment

Review Completed

Marked out of 18.00

A 52-year-old woman presents with sudden severe headache and vomiting unresponsive to paracetamol and codeine. She has migraine, depression, atrial fibrillation, and poorly controlled hypertension. Her medications include fluoxetine, rivaroxaban, enalapril, and atenolol.

List three (3) diagnoses and two (2) historical features supporting each.

(Marked out of 9.0)

Diagnosis	Two supporting historical features
1.
2.
3.

/ 9

After diagnosing acute migraine, list three (3) parenteral treatments from different drug classes. Include dose and route, one advantage, and one disadvantage for each.

(Marked out of 9.0)

Drug, dose, route	Advantage	Disadvantage
1.
2.
3.

/ 9

Total Score: 0 / 18

Percentage: 0%

Diagnosis	Supporting features
Subarachnoid haemorrhage	Sudden or maximal-at-onset headache; hypertension; anticoagulation; headache differs from previous migraine.
Spontaneous intracerebral haemorrhage	Poorly controlled hypertension and rivaroxaban use.
Migraine	Previous neurologist-diagnosed migraine, vomiting, aura, unilateral or pulsatile pain.

Treatment	Advantage	Disadvantage
Metoclopramide 10-20 mg IV	Treats vomiting as well as headache.	Dystonia, akathisia, drowsiness, and limited efficacy alone.
Ketorolac 15-30 mg IV or IM	Provides NSAID therapy despite vomiting.	Renal injury, gastritis/PUD, or bronchospasm.
Dexamethasone 10-25 mg IV or IM	Adjunct that may reduce early recurrence.	Mood effects, gastritis, immunosuppression, and limited acute efficacy.
Propofol 20 mg IV titrated every five minutes	Short duration of action.	Apnoea, hypotension, and requires monitored resuscitation setting.

← Previous SAQ Next SAQ →