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:

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:

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:

Accepted Answer

A

Question 4

When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include:

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:

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:

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?

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:

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:

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:

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:

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?

Accepted Answer

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

Question 13

When prescribing for migraines, patient education includes:

Accepted Answer

Stress reduction and regular sleep are important non-pharmacological strategies in managing migraines, as they can help reduce the frequency and severity of migraine attacks. Lifestyle modifications, including stress management and maintaining a regular sleep schedule, are key components of comprehensive migraine care.

Question 14

Preventative therapy for cluster headaches includes:

Accepted Answer

Ergotamine is used as a preventative treatment for cluster headaches, often taken at night to prevent nocturnal attacks.

Question 15

A patient has been diagnosed with cluster headaches. Appropriate acute therapy would be:

Accepted Answer

Oxygen 100% for 15 to 30 minutes is a recognized acute therapy for cluster headaches, providing rapid relief for many patients.

Quiz 37: Headaches

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: