A Less Common Indication for High-Flow Oxygen
A look back at an ER visit for an ongoing painful headache.
By Marven Ewen, MD
Medical Director
Late one evening, a 36-year-old man presented to the ER with a severe stabbing right sided headache. As he rocked back and forth holding his head he told me that he had been getting this same headache intermittently throughout the day and night over the past few days. He said last year the headaches recurred like this every day for about 6 weeks.
He described a sharp, stabbing headache in the area of his right periorbital area that would occur several times a day lasting approximately 45 min to an hour. He came to the ER because he said he just couldn’t take it anymore. He had tried aspirin and ibuprofen without relief.
Other than the prior episode of recurrent headaches, his past history was unremarkable except for a closed head injury a few years ago from playing soccer. He admitted to smoking 1 pack of cigarettes per day for the last 20 years. His family history was positive for headaches. His father would have bouts of headaches causing him to miss work.
On exam, I asked him to try and stop moving, as he was restless. His vital signs were normal and he was afebrile. His neck was soft and the neurological exam was unremarkable except for the miosis (small or constricted pupil) of his right eye and redness of the conjunctiva. Also, his right eye was tearing.
This presentation was consistent with cluster headaches, called that because the headaches occur in clusters over a few weeks, then go away, often for many months at a time. I immediately placed the patient on 100% oxygen via NRB at 15L/min. Within 5 minutes he reported the pain had subsided. I had him continue with the oxygen for a full 15 minutes to avoid the headache returning.
Prior to discharge from the ER, I gave the patient prescriptions for prednisone taper and verapamil to be taken daily as a preventative treatment. He was also given a prescription for Sumatriptan to take if the headache was to recur. I suggested he consider being a non-smoker as smoking is a risk for cluster headaches (in addition to all the other havoc smoking causes to the body).
More from The Allied Times
One Punch An ER visit with the reasons why one punch is really all it takes.By Marven Ewen, MDMedical DirectorIn Hollywood movies, during fight scenes, the characters often take multiple blows to the face and yet continue fighting with minimal apparent injury. This is not true in real life. I recall the first time…
Maximizing Protein Intake for Optimal Health and Vitality How much protein do we really need?By Mariah Xzena Briones, RMTCertification SpecialistProtein is a crucial macronutrient that plays a vital role in our overall health and well-being. While protein has long been recognized as an essential component of our diet, emerging evidence suggests that the recommended protein…
A Less Common Indication for High-Flow Oxygen A look back at an ER visit for an ongoing painful headache.By Marven Ewen, MDMedical DirectorLate one evening, a 36-year-old man presented to the ER with a severe stabbing right sided headache. As he rocked back and forth holding his head he told me that he had been…
POEMS SyndromeThe rare blood disorder named for its symptoms.By Jenny Ewen, BA, NREMTEditor-In-ChiefPOEMS syndrome is a rare blood disorder suspected to affect up to 5000 people in the USA, primarily men who are in later adulthood (around age 50). This syndrome damages the nerves and organs due to an increased number of abnormal plasma cells with…
Meet AMT: Dr. Ewen We interview our staff members for details on their EMS journey.When/why did you first become interested in becoming a doctor/working in the medical field? At the time I started to think about going to medical school I was an undergraduate with a major in psychology. I was interested in a career…
Meet AMT: Shannon Z. We interview our staff members for details on their EMS journey.When/why did you first become interested in becoming an EMT/working in EMS? Throughout my entire career spanning 30+ years, I have had many positions that required a safety background including OSHA, Workers Comp, Safety Committee Chair, Accident Investigations, etc. Being involved…