Question 1

Jayla is a 9-year-old patient 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?

Accepted Answer

Propranolol is a beta-blocker that has been approved by the FDA for use in children with migraines. It is taken daily for at least 3 months and has been found in clinical trials to significantly reduce the frequency and severity of migraines in children. The other options are not appropriate for various reasons. Amitriptyline is not FDA-approved for use in children with migraines and can have significant side effects. Encouraging the use of Excedrin Migraine on a regular basis can lead to medication overuse headaches. Ordering an MRI without additional symptoms or indications would not be clinically appropriate.

Question 2

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 typically recur when the medication wears off, leading to a cycle of frequent use and worsening headache patterns.

Question 3

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

Accepted Answer

Oxygen 100% for 15 to 30 minutes is the most effective acute therapy for cluster headaches. It is recommended as first-line therapy in the treatment of acute attacks. Butalbital and aspirin and meperidine are not recommended for the treatment of cluster headaches. Indomethacin may be effective for a specific type of headache (Hemicrania Continua) but is not recommended for the treatment of cluster headaches.

Question 4

Juanita presents to the 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:

Accepted Answer

Naproxen (Aleve) is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve headache pain and reduce inflammation. In addition to medication, keeping a headache diary can help identify triggers and patterns for the headaches. The other options are not indicated for tension headaches. Sumatriptan (Imitrex) is used for migraines, ergotamine (Ergostat) is used for cluster headaches, and Tylenol with codeine (Tylenol #3) is a narcotic pain reliever that is not typically used for tension headaches.

Question 5

Amber is a 24-year-old patient 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:

Accepted Answer

A) Naratriptan is contraindicated with SSRIs and St John's wort because it can cause serotonin syndrome. It's important for healthcare providers to know about Amber's migraines and the medications she is taking.
B) If Amber's migraines are consistently happening around her menses, there are hormonal preventive therapies available, such as birth control pills or a progesterone-only medication.
C) Triptans are contraindicated during pregnancy because their safety has not been established for use during pregnancy.

Question 6

Migraines in pregnancy may be safely treated with:

Accepted Answer

Acetaminophen with codeine (Tylenol #3) is considered safe for use in pregnancy and can help alleviate migraine pain. The other options (B, C, and D) are not recommended during pregnancy due to potential risks to the fetus.

Question 7

Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes:

Accepted Answer

The goal of treatment with migraine preventive medication is typically to reduce the frequency of migraine occurrence by 50% or more. Option A is incorrect because preventive medication is typically taken on a daily basis, not just at the onset of a headache. Option B is incorrect because medication is often used in conjunction with other preventive strategies, such as stress reduction techniques or dietary changes. Option C is also incorrect because there is typically no set limit on the number of doses per month, but rather medication is taken on a daily or weekly basis as prescribed by a healthcare provider.

Question 8

When prescribing for migraines, patient education includes:

Accepted Answer

Patient education should include stress reduction techniques and the importance of regular sleep as these can help prevent migraines or reduce their severity.

Answer: B
 Patients should try triptans before using over-the-counter medications like acetaminophen or naproxen, as these medications may not be effective for migraines.

Therefore, the best choices are B and C.

Question 9

Vicky, age 56 years, 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

It is appropriate to assess how often the patient is using Fiorinal and refill her medication if she has been taking it for over 2 years and is satisfied with its ability to abort her migraines. However, it may also be appropriate to assess if the medication is still effective or if she is experiencing any adverse effects from long-term use. It is important to monitor medication use and assess the need for continued treatment.

Question 10

Kelly is a 14-year-old patient who 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

The initial treatment plan for Kelly should involve prescribing NSAIDs as an abortive therapy to treat her migraines and having her keep a headache diary to identify potential triggers. This approach will allow for a low-risk treatment option that can be adjusted as needed based on her individual response to medication and symptom presentation. It will also provide valuable information about her migraines, which can be used to guide further treatment decisions in the future.

Question 11

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

Accepted Answer

Ergotamine can cause nausea and vomiting, so premedication with an antinausea medication may be necessary to improve tolerability. Option A is incorrect, as there is no evidence to suggest that ergotamine worsens the migraine before resolving it. Option B is also incorrect, as while bradycardia and dizziness are potential side effects of ergotamine, they are not the most important aspects of patient education. Option D is incorrect, as the dose of ergotamine should be individualized based on the patient's symptoms and response to treatment.

Question 12

Preventative therapy for cluster headaches includes:

Accepted Answer

Ergotamine is used as a preventative treatment for cluster headaches when taken nightly before bed.

Question 13

Nonpharmacologic therapy for tension headaches includes:

Accepted Answer

All of the above options (biofeedback, stress management, and massage therapy) are appropriate nonpharmacologic therapies for tension headaches. Biofeedback helps individuals learn to control their muscle tension and decrease headache frequency and severity. Stress management techniques, such as meditation and relaxation strategies, can reduce overall stress levels and potential headache triggers. Massage therapy can help reduce muscle tension and alleviate headache pain. Combining these therapies may provide even greater relief for individuals with tension headaches.

Question 14

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 15

Xi, a 54-year-old female, has a history of migraines that do 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:

Accepted Answer

Since Xi has a history of migraines and the medication she is requesting requires observation with the first dose due to potential side effects, it would be best to arrange for her to be observed in the clinic or urgent care with the first dose. This will ensure her safety and allow for any necessary adjustments to her treatment plan.

Quiz 35: Headaches