A 20 year old female medical student presents to her GP with recurrent band-like tightness and dull pain in both sides of her head for the past month. It is not present on waking but gets gradually worse throughout the day, particularly when she misses meals or is feeling particularly stressed. She denies any nausea or vomiting.

She has started meditating which has improved her pain somewhat, but not completely. She has no past medical history and does not take any medications. She has had a previous anaphylactic reaction to aspirin.

Which of the following is the most appropriate treatment?

Options:
explanation: This vignette describes a case of tension headache, which could be deduced from the bilateral, 'band-like' description of the pain, in addition to stress being an associated factor. Analgesic treatment should follow the WHO pain ladder; typically starting with paracetamol or an NSAID. Since she is allergic to aspirin, the use of aspirin or other NSAIDs, such as ibuprofen or naproxen, should be avoided. Hence, the best drug is paracetamol at this stage. Co-codamol is a mixture of paracetamol and codeine (an opioid). It should only be used when paracetamols and NSAIDs alone have not worked.
name: Co-codamol
label: d
answer: no
explanation: This vignette describes a case of tension headache, which could be deduced from the bilateral, 'band-like' description of the pain, in addition to stress being an associated factor. Analgesic treatment should follow the WHO pain ladder; typically starting with paracetamol or an NSAID. Since she is allergic to aspirin, the use of aspirin or other NSAIDs, such as ibuprofen or naproxen, should be avoided. Hence, the best drug is paracetamol at this stage. Sumatriptan is commonly used to treat migraines, which are characterised by severe and classically unilateral head pain, along with other symptoms such as nausea and sensitivity to light and sound. It is not typically used for tension headaches, making this option incorrect.
name: Sumatriptan
label: e
answer: no
explanation: This vignette describes a case of tension headache, which could be deduced from the bilateral, 'band-like' description of the pain, in addition to stress being an associated factor. Analgesic treatment should follow the WHO pain ladder; typically starting with paracetamol or an NSAID. Since she is allergic to aspirin, the use of aspirin or other NSAIDs, such as ibuprofen or naproxen, should be avoided. Hence, the best drug is paracetamol at this stage. Codeine is an opioid medication that can be used in the management of severe pain. However it is not typically a first-line treatment for tension-type headaches, and it carries a risk of side effects and dependence when used long-term. Paracetamol should first be trialled.
name: Codeine
label: c
answer: no
explanation: This vignette describes a case of tension headache, which could be deduced from the bilateral, 'band-like' description of the pain, in addition to stress being an associated factor. Analgesic treatment should follow the WHO pain ladder; typically starting with paracetamol or an NSAID. Since she is allergic to aspirin, the use of aspirin or other NSAIDs, such as ibuprofen or naproxen, should be avoided. Hence, the best drug is paracetamol at this stage.
name: Ibuprofen
label: b
answer: no
explanation: This is the correct answer. This vignette describes a case of tension headache, which could be deduced from the bilateral, 'band-like' description of the pain, in addition to stress being an associating factor. Analgesic treatment should follow the WHO pain ladder; typically starting with paracetamol or an NSAID. Since she is allergic to aspirin, the use of aspirin or other NSAIDs, such as ibuprofen or naproxen, should be avoided. Hence, the best drug is paracetamol at this stage.
name: Paracetamol
label: a
answer: yes

Correct answer: a