headache 6

Question 1

what is the best way to achieve trigger avoidance for headaches

Answer 1

keep a headache diary

Question 2

when should a triptan be taken for acute therapy of migraine with aura

Answer 2

when the headache starts; not during aura (causes more constriction)

Question 3

what patient educated is needed for preventative migraine therapies

Answer 3

1. take daily
2. may take up to 6 months to see full effect
3. breakthrough headaches don’t mean failure

Question 4

what is status migrainosus

Answer 4

headache lasting longer than 72 hours (up to 1 week)

Question 5

If someone comes to ER with status migrainosus and has been on tripan or DHE at home should be started on what?

Answer 5

IV valproic acid

Question 6

what is always premedicated with reglan

Answer 6

IV DHE

Question 7

what are two new drugs that target CGRP

Answer 7

olcegepant and telcegepant

Question 8

what is the benefit of targeting CGRP

Answer 8

no vasoconstriction

Question 9

what are the most common medications that cause medication overuse headaches

Answer 9

narcotic use

butalbital

Question 10

what is the term for tension headaches experienced less than once per month

Answer 10

episodic

Question 11

what characterizes a tension headache

Answer 11

1. bilateral
2. tightening/ pressing (non-pulsating)
3. not aggrevated by physical activity
4. no nausea or vomiting
5. not experiencing both photophobia and phonophobia

Question 12

what has the most evidence in the prevention of tension headaches

Answer 12

1. TCA’s (best)
2. topiramate
3. gabapentin

Question 13

what are the characteristics of a cluster headache

Answer 13

1. very severe
2. unilateral
3. orbital
4. supraorbital
5. temporal

Question 14

what are the symptoms of cluster headaches

Answer 14

1. nasal congestion
2. eyelid edema
3. facial sweating
4. red eyes/ tearing
5. restlessness or agitation

Question 15

what is abortive therapy for managing a cluster headache attack

Answer 15

1. 12 L of oxygen for 15-30 minutes
2. ergotamine - fastest
3. triptan - SQ or nasal

Question 16

what is the prophylactic treatment for cluster headaches

Answer 16

1. verapamil in high doses

2. lithium (always for cluster headaches only)

Question 17

what is the best prophylxis for nocturnal cluster headaches

Answer 17

1. ergotamine

2. corticosteroids

Question 18

what should be monitored when keeping a headache diary

Answer 18

1. frequency
2. intensity
3. duration
4. change in pattern

Question 19

If headache starts with a loud clap, what would you recommend

Answer 19

go to emergency room ( or if worst headache of life)

Question 20

If someone has a tension headache but once something stronger than ibuprofen what would you recommend

Answer 20

go see doctor for prophylaxis treatment