Concluded Case

Headache

Headache with thrombbing pain in the conditions of nosey area, traveling, smells,in sun light _ last for 6 month with behaved irritable. 56 years old female. Chief Complaints Headache with thrombbing pain in left side orbital site... History No family history DM Vitals Normal blood pressure Physical Examination Vision mild unclear Investigations CT scan Brain normal RBS normal in range. Diagnosis Cluster headache/ migraine Management To Given previously in outside medicines are Amitriptyline 25 mg, propranolol 20mg BD, flupherazin and Diclo

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Concluded answer

MRI Brain, plus PNS, n also to rule out Trigeminal neuralgia,tab gabapin-N n Amitriptyline may be given

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Correction of vision. Opthalmologist opinion regarding retinal condition and other mainly xerophthalmia and cataract. CT angiography of neck. Till reports complied. Azithro 500mg od. Soluzyme TDS before meal. PCM+ stemetil bd and stemetil MD during headache. Angiolytic SOS HS. Avoid oily spicy and fast food. Use mask .

Thanks Dr Dinesh Gupta
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More details about history...like...the symptoms occuring first time or used to have episodes of such.... family h/o...such headache...how triggered. like exposed to heat..lack of sleep ?..how relieved.. ? etc...full investigation like mri brain with orbit plus biochemistry....to start...for scut attak...cetadom...or... naprosyn or naxdom 250 ..sos ..not more than thrice a day...for.. prophylaxis...topiramate....start..12.5.mg....gradully to 50..or more as per response.... propranolol at this age..may not be preferable..but if one want to give exclude asthma..postural hypotension....flunarizine notorious for wt gain and sleepy...may also think divalproex sodium if liver enzymes normal...

Also..if associated with insomnia amitriptyline may be thought... neurologist opinion must
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Dear Dr. Anil Tabiyar Sir, Advice for the case according to ayurvedic system of medicines. Advice for Nashya Karma . Tab. Shirah Shuladi Vajra Ras 1 tds. Give Wheat halva ( Shiro ) in tne early morning.

ADVISABLE E. E. G M. R. I AND SYMPTOMATIC MANAGEMENT... TILL .... . REPORTS

Pt may b having SINUSITIS (FRONTAL). He should have ENT Surgeon opinion. Presence of any stress. As irritability is reported. May b referred to Psychologist for

Counseling n relaxation exercises
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Tab. Dmp plus. TDS. Tab. Somperz 40mg. OD. BBF Tab. Melzep MD. 2.5 mg.. HS. Avoid oily spicy and fast food. Wear mask in public areas. Yoga in anulom bilom & kapal Bharti .Arley morning.. Investigation. EEG, MRI brain. Neurologist openion required.

Unilateral throbbing pain and sudden onset decrease in vision can also be suggestive e of optic neuritis too....better to get a MRI orbit with MRI brain.

MRI Brain, plus PNS, n also to rule out Trigeminal neuralgia,tab gabapin-N n Amitriptyline may be given

Tab Amitriptyline 25mg bd Tab fluneraziine 10mg bd Tab Alprazolam 0.25 bd

Diseases Related to Discussion

Cluster Headache
Xerophthalmia
Optic Neuritis
Neuritis
Sinusitis
Trigeminal Neuralgia
Asthma

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