Martes 28 de Junio 2016

Adriana es una paciente de 40 años.  Es ama de casa y no tiene antecedentes médicos diferentes al que motiva esta visita a su consultorio. 

Manifiesta que desde que es adolescente generalmente en la época del año cercana a Semana Santa presenta dolor de cabeza severos. Ha tenido años en los que no los presenta. 

En este momento se encuentra sin dolor, pero manifiesta que está en la época en la que la mayoría de las noches presenta crisis de dolor severo hemicraneal derecho, que tiene un énfasis en la región periorbitaria. El examen físico neurológico es normal. 

Estas crisis duran cerca de media hora, son severas 10/10.  Dice que el ojo se hincha y se pone rojo. 

Las crisis de dolor la ponen muy nerviosa e intranquila.   De hecho ha tenido ataques de pánico asociados. 

En el pasado ha tenido muchos analgésicos pero recuerda especialmente amitriptilina, pregabalina, verapamilo, cortisona y sumatriptian.   Nunca le han hecho un bloqueo. 

Está siendo manejada con Litio 600mg al día y para las crisis usa un medicamento llamado Cafergot y se pone una cánula de oxígeno lo cual no está sirviendo. Muchas veces se inyecta diferentes AINES. 

Esta deprimida y asiste a su consulta solicitando ayuda. Ha pensado en quitarse la vida. 

1. Cuál es el problema. 

2. Como se clasifica este tipo de cefalea. Que sistema de clasificación propone

3. Que esquema de tratamiento estructurado, basado en la evidencia propone. 

Why Should I Take the FIPP Examination?

Philippe Mavrocordatos MD, FIPP WIP Honorary Secretary Lausanne, Switzerland

Dear Friends, I was recently asked what I would say to someone who was considering taking the FIPP Examination.  When I took my FIPP exam in 2007, I already had 10 years of interventional pain practice, excellent training, and felt quite confident in my daily routine.  By chance, I met some colleagues who suggested me to take the FIPP exam. I did not feel I really needed it, but found the idea interesting.  Well, I didn't know how much this exam would change my professional life.

Locally, my daily practice improved significantly. The FIPP certification made me feel more confident, I was up to date with my readings and also with my techniques.. Interestingly, it also had an important impact on my referrals, as local physicians knew they had a real specialist to talk to and not just another anesthesiologist doing pain. Nationally, it helped me build up our interventional pain society, and I based our post-graduate education on clear and validated criteria to set up and develop the pain specialty. I also knew I could count on the support of my FIPP peers for questions and exchanges. Internationally, it was probably for me the biggest surprise. I got invited to teach, and to examine colleagues who now are close friends, people with whom I have frequent exchanges. We have common projects and learn from each other. For me, the FIPP exam and the WIP organization in general changed my understanding of pain and made me a part of a worldwide network; I now feel part of this professional family! I hope these words will encourage you to study for and take the FIPP Examination in the near future. It changed my life, and will change yours as well! Cheers, philippe For more details about the examination, including sample MCQs and recommended references, please review the FIPP Information Bulletin, available in PDF format at http://bit.ly/fippinfo16.  To apply for the examination, please visit the online application system at http://bit.ly/fippapp.

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