Ease Into Prep with a USMLE^® Step 2 CK Question of the Day

The correct answer is A. The clinical presentation is characteristic of cluster headache. In its classic form, cluster headache manifests as nocturnal attacks that last between 30 minutes and 2 hours. These are often precipitated by alcohol consumption and recur daily for up to eight weeks. Each "cluster" is then followed by a pain-free interval lasting for one year on average. The pathogenesis is probably related to disturbances of the serotoninergic pathways originating from the raphe nuclei. Acute attacks may be shortened by oxygen, sumatriptan, and ergotamine preparations. Verapamil is typically used as a prophylactic agent to prevent clusters.

Depression headache (choice B) is often worse in the morning and is frequently associated with other manifestations of depression.

The headache due to giant cell arteritis (choice C) usually manifests in elderly patients and is associated with scalp tenderness over the affected superficial temporal artery. Systemic signs and symptoms can be present, including myalgia, weight loss, and malaise. The erythrocyte sedimentation rate is elevated.

Classic cases of migraine (choice D) begin in early adulthood and manifest as episodic unilateral throbbing headache, often associated with nausea, photophobia, and visual symptoms.

Tension headache (choice E) has a diffuse, band-like character and feels worse in the back of the head. Pain slowly increases and may last for many hours or even days.

Trigeminal neuralgia (choice F) is a disorder of the sensory nucleus of CN V that produces episodic, severe, and lancinating pain in the distribution of one or more divisions of the trigeminal nerve. Pain is often precipitated by well-defined trigger zones (e.g., washing or shaving) and is not associated with Horner syndrome or rhinorrhea.