Question 1

Jayla is a 9 year old who has been diagnosed with migraines for almost 2 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 dose slowly every 2 weeks until 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 3 months
D) Explain that it is rare for a 9 year old to get migraines and she needs an MRI to rule out a brain tumor

Accepted Answer

Prescribe propranolol (Inderal)to be taken daily for at least 3 months

Question 2

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

Accepted Answer

Ergotamine can cause nausea and vomiting, so patients may need to take an anti-nausea medication before taking the suppository to minimize these side effects. Choices A, B, and D are not accurate statements about ergotamine suppositories.

Question 3

Amber is a 24 year old who 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 Amber's naratriptan education would include:

A) Naratriptan will interact with antidepressants,including SSRIs and St John's Wort,and she should inform any providers she sees that she has migraines
B) Continue to monitor her headaches,if the migraine is 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

All of the education points mentioned in options A, B, and C are important for Amber to know when refilling naratriptan. Option A emphasizes the need for Amber to inform any healthcare provider she sees about her migraines and the use of naratriptan, especially if she is taking any antidepressants. Option B highlights the importance of monitoring her headaches for patterns and considering preventive therapy if her migraines consistently happen around her menses. Option C reminds Amber that triptans, including naratriptan, are contraindicated in pregnancy, and she should use appropriate contraception if sexually active.

Question 4

When prescribing for migraine,patient education includes:&#10;A) Triptans are safe to be used 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

Accepted Answer

Triptans should not be overused and should be taken as directed by a healthcare provider. It is also important to try OTC medications before resorting to triptans. Stress reduction, adequate sleep, and other lifestyle modifications can also help prevent migraines and manage symptoms. Increasing medication without consulting a healthcare provider can be dangerous and should be avoided.

Question 5

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

Accepted Answer

Oxygen therapy is considered the first-line treatment for acute cluster headaches. It is safe, effective, non-invasive, and has minimal side effects. Meperidine is not recommended for cluster headaches as it can lead to rebound headaches and addiction. Butalbital and aspirin may provide some relief, but they are not specific treatments for cluster headaches. Indomethacin is not effective for cluster headaches.

Question 6

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

Accepted Answer

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

Question 7

Paige has a history of chronic migraines and would benefit from preventative 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%

Accepted Answer

The goal of treatment for migraine prevention is typically to reduce occurrence by 50%. Option A is incorrect because migraine preventative medication is actually taken daily to prevent the onset of migraines, not at the beginning of a headache. Option B is incorrect because medication is often just one component of a comprehensive approach to migraine management, which may also include lifestyle changes such as identifying and avoiding triggers, improving sleep habits, and stress reduction techniques. Option C is also incorrect because preventative medication may be taken daily, not just four times a month.

Question 8

Vicky,age 56 years,comes to 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 migraine 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 medication
C) Switch her to a beta-blocker such as propranolol to prevent her migraine
D) Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines

Accepted Answer

It is important to assess how often Vicky is using Fiorinal to ensure she is not overusing it, which can lead to medication overuse headaches. Refilling her medication as needed is appropriate as long as she is not overusing it. Switching her to sumatriptan or a beta-blocker may be options, but this decision should be made after further evaluation and discussion with the patient. Option D is not a helpful or patient-centered approach.

Question 9

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)

Accepted Answer

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

Question 10

Xi,a 54-year-old female,has a history of migraine that does not respond well to 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 Maxalt,but only give her four tablets with no refills to monitor the use
B) Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose
C) Explain that rizatriptan is not used for post-menopausal migraines and recommend Fiorinal (aspirin and butalbital)
D) Prescribe sumatriptan (Imitrex)with the explanation that it is the most effective triptan

Accepted Answer

Maxalt (rizatriptan) is a triptan medication used for acute treatment of migraines. Since the patient has a history of migraines that do not respond to OTC medication, it is reasonable to consider a triptan. However, as with any new medication, it is important to monitor the patient closely for any adverse reactions or side effects. Therefore, arranging for observation in the clinic or urgent care with the first dose is the safest and most appropriate decision.

Question 11

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

Accepted Answer

The answer of Nonpharmacologic therapy for tension headaches includes:&#10;A) Biofeedback&#10;B)...

Question 12

Kelly is a 14 year old who presents to 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 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

Accepted Answer

The answer of Kelly is a 14 year old who...

Question 13

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)

Accepted Answer

The answer of Migraines in pregnancy may be safely treated...

Question 14

Juanita presents to clinic with a complaint of headaches off and on for months.She reports they feel 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 a prescription for:

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

Accepted Answer

The answer of Juanita presents to clinic with a complaint...

Question 15

When prescribing any headache therapy,appropriate use of medications needs to be discussed to prevent medication-overuse headaches.The clinical characteristics of medication-overuse headaches include:&#10;A) Headaches are increasing in frequency&#10;B) Headaches are increasing in intensity&#10;C) Headaches recur when medication wears off&#10;D) Headaches begin to &#34;cluster&#34; into a pattern

Accepted Answer

The answer of When prescribing any headache therapy,appropriate use of...

Deck 35: Headaches