Hematology and oncology Videos & Books 2021

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Educational objective: Medication overuse headache is characterized by chronic, near-daily headache in the setting of regular use of acute headache medications in patients with a preexisting headache disorder. Common features include headache that is present upon awakening and brief symptom relief followed by rebound pain. Management involves cessation of the culprit medication.

Which of the following is the most appropriate next step in management of this patient?

A 36-year-old woman comes to the office due to headaches. Over the past 3 months the patient has had constant, bilateral headaches almost every day shortly after awakening. She has had intermittent episodes of migraines since adolescence, but her current headaches are more frequent though milder. The patient has been taking over-the-counter analgesics several times a day. She has had no focal weakness, numbness, or vision changes. The patient has no other medical conditions and does not use tobacco, alcohol, or illicit drugs. Vital signs are within normal limits. BMI is 24 kg/m2. Physical examination, including funduscopy and neurological examination, shows no abnormalities. Blood cell counts and serum chemistry studies are within normal limits.

Educational objective: Guillain-Barre syndrome (GBS) is characterized by ascending weakness, bulbar symptoms (eg, dysarthria) and respiratory compromise after antecedent illness such as respiratory or gastrointestinal infection (especially Campylobacter jejun1). Cerebrospinal fluid analysis shows albuminocytologic dissociation. Treatment of GBS includes intravenous immunoglobulin or plasmapheresis.