Deck 44: Migraine Medications

Question 1

A patient who has migraine headaches tells the primary care NP that drinking coffee and taking nonsteroidal antiinflammatory drugs (NSAIDs)seems to help with discomfort.The NP should tell the patient that:

A) this combination can lead to longer lasting headache pain.
B) these substances are not indicated for migraine headaches.
C) doing this can increase the risk of more chronic migraines.
D) an opioid analgesic would be a better choice for migraine pain.

Answer 1

this combination can lead to longer lasting headache pain.

Question 2

A patient who has migraine headaches without an aura reports difficulty treating the migraines in time because they come on so suddenly.The patient has been using over-the-counter NSAIDs.The primary care NP should prescribe:

A) frovatriptan (Frova).
B) sumatriptan (Imitrex).
C) cyproheptadine (Periactin).
D) dihydroergotamine (D.H.E. 45).

Answer 2

sumatriptan (Imitrex).

Question 3

A patient comes to the clinic and reports recurrent headaches.The patient has a headache diary,which reveals irritability and food cravings followed the next day by visual disturbances and unilateral right-sided headache,nausea,and photophobia lasting 2 to 3 days.The NP should recognize these symptoms as _____ migraine.

A) classic
B) hemiplegic
C) basilar-type
D) ophthalmoplegic

Answer 3

classic

Question 4

A patient who has migraine headaches usually has two to three severe migraines each month.The patient has been using a triptan nasal spray but reports little relief and is concerned about missing so many days of work.The primary care NP should consider:

A) an oral triptan plus an opioid analgesic.
B) an injectable triptan plus an oral corticosteroid.
C) an intramuscular steroid plus an opioid analgesic.
D) dihydroergotamine hydrochloride plus an opioid analgesic.

Question 5

A patient takes rizatriptan (Maxalt)to abort migraine headaches but tells the primary care NP that the headaches have become more frequent since a promotion at work.The NP's initial response should be to:

A) prescribe topiramate (Topamax).
B) stress the importance of establishing new routines.
C) help the patient identify stressors associated with the new role.
D) add a combination NSAID, aspirin, and caffeine product to the regimen.

Question 6

A patient comes to the clinic concerned about possible migraine headaches.The primary care NP conducts a history and physical examination,and the patient describes vise-like pressure in the back of the head that occurs almost daily during the work week.The NP should recommend:

A) acetaminophen.
B) topiramate.
C) sumatriptan.
D) ergotamine.

Question 7

A patient reports frequent headaches to the primary NP.The patient describes the headaches as unilateral and moderate in intensity,accompanied by nausea,vomiting,and photophobia.There is no aura,and the headaches generally last 24 to 48 hours.The NP should:

A) prescribe dihydroergotamine (D.H.E. 45).
B) prescribe topiramate (Topamax) as migraine prophylaxis.
C) recognize these as classic migraines and order sumatriptan (Imitrex).
D) suggest treatment with acetaminophen because these are probably tension headaches.

Question 8

A patient who has migraine headaches takes sumatriptan as abortive therapy.The patient tells the primary care nurse practitioner (NP)that the sumatriptan is effective for stopping symptoms but that the episodes are occurring three to four times per month.The NP should consider the addition of:

A) aspirin.
B) topiramate.
C) ergotamine.
D) opioid analgesics.

Question 9

A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan,the frequency of episodes has increased to three or four times each month.The NP should:

A) add a selective serotonin reuptake inhibitor (SSRI) antidepressant.
B) change to dihydroergotamine hydrochloride.
C) prescribe a b-blocker such as propranolol.
D) prescribe an anticonvulsant such as topiramate.

Question 10

A patient who has mild to moderate migraine headaches has severe nausea and vomiting with each episode.For the best treatment of this patient,the primary care NP should prescribe:

A) triptan nasal spray.
B) metoclopramide and aspirin.
C) an NSAID and prochlorperazine.
D) sumatriptan and metoclopramide.

Question 11

A primary care NP prescribes sumatriptan for abortive treatment of migraine headaches.The patient returns to the clinic 1 month later to report increased frequency of the headaches.The NP should:

A) add an opioid analgesic.
B) consider changing to dihydroergotamine (D.H.E. 45).
C) suggest that the patient take sumatriptan with a NSAID.
D) ask the patient how often the sumatriptan is used each week.

Question 12

A patient who is diagnosed with migraine headaches has a history of cardiovascular disease and hypertension.The NP should prescribe:

A) triptan nasal spray.
B) rizatriptan (Maxalt).
C) cyproheptadine (Periactin).
D) dihydroergotamine (D.H.E. 45).