AANP Family Nurse Practitioner (FNP) Certification ExamPlanHard
A 35-year-old female presents with recurrent episodes of acute, severe, unilateral head pain associated with ipsilateral ptosis, miosis, and conjunctival injection. Each episode lasts approximately 45-90 minutes and occurs several times a day. She reports significant distress and impact on her daily life. Which of the following is the most appropriate acute pharmacological treatment for this condition?
- ASubcutaneous sumatriptan 6 mg
- BOral prednisone 60 mg
- COral ibuprofen 800 mg
- DOral sumatriptan 100 mg
Show answer & explanationAnswer & explanation
Correct answer: A. Subcutaneous sumatriptan 6 mg
The patient's symptoms (unilateral severe head pain, ptosis, miosis, conjunctival injection, short duration, high frequency) are classic for cluster headache. For acute cluster headache, oxygen therapy and subcutaneous sumatriptan are the most effective first-line treatments. Oral triptans are generally too slow to act for the rapid onset and short duration of cluster attacks.
Why the other options are wrong
- B. Oral prednisone is used for cluster headache prophylaxis (transitional treatment) but is not an effective acute abortive treatment for an ongoing attack.
- C. NSAIDs like ibuprofen are generally ineffective for the severe pain of acute cluster headache.
- D. Oral sumatriptan has a delayed onset of action and is generally not effective for the rapid, severe attacks of cluster headache.
Acute Cluster Headache Treatment
Acute cluster headache attacks require rapid-acting treatments due to their severe, sudden onset and short duration.
- High-flow oxygen (100%) is a first-line acute treatment.
- Subcutaneous sumatriptan is another highly effective first-line acute treatment.
- Oral medications are generally too slow for acute attacks.
Memory trick: Cluster Attacks Need Quick Shots (Sumatriptan) or Oxygen!