Question 1

A 24-year-old patient has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling her naratriptan, education would include:

A)Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St. John's Wort, and she should inform any providers she sees that she has migraines.
B)Continue to monitor her headaches, and if the migraines are consistently happening around her menses there is preventive therapy available.
C)Pregnancy is contraindicated when taking a triptan.
D)All of the above

All of the above

Accepted Answer

Naratriptan, like other triptans, can interact with antidepressants, including SSRIs and St. John's Wort, due to the risk of serotonin syndrome. Monitoring migraines for patterns related to menses is important as there are specific preventive therapies for menstrual migraines. While not absolutely contraindicated, pregnancy considerations are important with triptans due to limited data on safety, making it crucial to discuss with healthcare providers. Therefore, all provided options are correct and important aspects of patient education for someone taking naratriptan.

Question 2

A patient presents to the clinic with a complaint of headaches off and on for months. She reports she feels like someone is "squeezing" her head. She occasionally takes Tylenol for the pain, but usually just "toughs it out." Initial treatment for tension headache includes asking her to keep a headache diary and giving her a prescription for:

A)Sumatriptan (Imitrex)
B)Naproxen (Aleve)
C)Ergotamine (Ergostat)
D)Tylenol with codeine (Tylenol #3)

Naproxen (Aleve)

Accepted Answer

Naproxen (Aleve) is a nonsteroidal anti-inflammatory drug (NSAID) that can be effective in treating tension headaches, which are often described as a feeling of tightness or pressure around the head. Sumatriptan and ergotamine are more specific for migraines, and Tylenol with codeine is generally not a first-line treatment due to the risk of dependence and side effects.

Question 3

Migraines in pregnancy may be safely treated with:&#10;A)Acetaminophen with codeine (Tylenol #3)&#10;B)Sumatriptan (Imitrex)&#10;C)Ergotamine tablets (Ergostat)&#10;D)Dihydroergotamine (DHE)&#10;

Accepted Answer

Acetaminophen with codeine (Tylenol #3)

Question 4

When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:&#10;A)Ergotamine will briefly make the migraine worse before the migraine resolves.&#10;B)The patient may experience bradycardia and dizziness.&#10;C)They may need premedication with an antinausea medication.&#10;D)Ergotamine works best if the patient starts off with a full suppository to get the full effect.&#10;

Accepted Answer

Ergotamine can cause nausea as a side effect, so premedication with an antinausea medication may be necessary to help manage this side effect.

Question 5

A 54-year-old female has a history of migraines that do not respond well to over-the-counter (OTC) migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:

A)Prescribe the rizatriptan, but only give her four tablets with no refills to monitor the use.
B)Prescribe rizatriptan and arrange to have her observed in the clinic or urgent care with the first dose.
C)Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).
D)Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Accepted Answer

Rizatriptan is a triptan used for acute migraine treatment. Observing the patient with the first dose can help monitor for any adverse reactions, especially if she has not used triptans before.

Question 6

A 14-year-old patient presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:&#10;A)Prescribe nonsteroidal anti-inflammatory drug (NSAIDs) as abortive therapy and have her keep a headache diary to identify her triggers.&#10;B)Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.&#10;C)Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine.&#10;D)Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.&#10;

Accepted Answer

NSAIDs are commonly used as first-line abortive therapy for migraines, especially in adolescents. Keeping a headache diary helps identify triggers and patterns, which is crucial for managing migraines effectively.

Question 7

A 9-year-old patient has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

A)Prescribe amitriptyline (Elavil) daily. Start at a low dose and increase dosage slowly every two weeks until it's effective in eliminating migraines.
B)Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.
C)Prescribe propranolol (Inderal) to be taken daily for at least three months.
D)Explain that it is rare for a 9-year-old child to get migraines and she needs magnetic resonance imaging (MRI) to rule out a brain tumor.

Accepted Answer

Propranolol is a beta-blocker that is effective in preventing migraines in children.

Question 8

When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they:

A)Increase in frequency
B)Increase in intensity
C)Recur when medication wears off
D)Begin to "cluster" into a pattern

Accepted Answer

Medication-overuse headaches are characterized by headaches that recur when the medication wears off.

Question 9

A patient with a history of chronic migraines would benefit from preventive medication. Education regarding migraine preventive medication includes:&#10;A)Medication is taken at the beginning of the headache to prevent it from getting worse.&#10;B)Medication alone is the best preventative against migraines occurring.&#10;C)Medication should not be used more than four times a month.&#10;D)The goal of treatment is to reduce migraine occurrence by 50%.&#10;

Accepted Answer

The goal of migraine preventive medication is indeed to reduce the frequency, severity, and duration of migraines by at least 50%, making option D correct. Preventive medications are typically taken on a regular basis, not just at the onset of a headache, and lifestyle changes alongside medication can also be important in managing migraines. There's no general rule that preventive medication should not be used more than four times a month; this advice might apply to certain acute treatments to avoid medication overuse headaches.

Question 10

Nonpharmacologic therapy for tension headaches includes:&#10;A)Biofeedback&#10;B)Stress management&#10;C)Massage therapy&#10;D)All of the above&#10;

Accepted Answer

All of the options listed, biofeedback, stress management, and massage therapy, are recognized nonpharmacologic therapies for managing tension headaches. These approaches can help reduce the frequency and severity of headaches by addressing some of the common triggers or contributing factors, such as stress and muscle tension.

Question 11

A first-line drug for abortive therapy in simple migraine is:&#10;A)Sumatriptan (Imitrex)&#10;B)Naproxen (Aleve)&#10;C)Butorphanol nasal spray (Stadol NS)&#10;D)Butalbital and acetaminophen (Fioricet)&#10;

Accepted Answer

The answer of A first-line drug for abortive therapy in...

Question 12

A 56-year-old female comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?

A)Switch her to sumatriptan (Imitrex) to treat her migraines.
B)Assess how often she is using Fiorinal and refill her medication.
C)Switch her to a beta blocker such as propranolol to prevent her migraine.
D)Recommend she take the Fiorinal daily to prevent migraine.

Accepted Answer

The answer of A 56-year-old female comes to the clinic...

Question 13

When prescribing for migraines, patient education includes:&#10;A)Triptans are safe to use as often as needed as long as the patient is healthy.&#10;B)Use triptan before trying OTC meds such as acetaminophen or naproxen.&#10;C)Stress reduction and regular sleep are integral to migraine treatment.&#10;D)If migraines worsen they are to increase their medication.&#10;

Accepted Answer

The answer of When prescribing for migraines, patient education includes:&#10;A)Triptans...

Question 14

Preventative therapy for cluster headaches includes:&#10;A)Massage or relaxation therapy&#10;B)Ergotamine nightly before bed&#10;C)Intranasal lidocaine four times a day during &#34;clusters&#34; of headaches&#10;D)Propranolol (Inderal) daily&#10;

Accepted Answer

The answer of Preventative therapy for cluster headaches includes:&#10;A)Massage or...

Question 15

A patient has been diagnosed with cluster headaches. Appropriate acute therapy would be:&#10;A)Butalbital and aspirin (Fiorinal)&#10;B)Intramuscular (IM) meperidine (Demerol)&#10;C)Oxygen 100% for 15 to 30 minutes&#10;D)Indomethacin (Indocin)&#10;

Accepted Answer

The answer of A patient has been diagnosed with cluster...

Deck 37: Headaches