Headaches

Question 1

migraine specific drugs for ACUTE therapy

Answer 1

• triptans
• ergot derivatives
• ditans
  caution/avoid in pregnancy, CVD, poor HTN
  -gepants

Question 2

migraine prophylactic drugs

Answer 2

beta blockers
TCAs
anti-epileptic
CoQ10, Magnesium, riboflavin
lithium (cluster headaches)
calcitonin gene related peptide (CGRP) quickest (erenumab, fremanezumab, ubrogepant)

Question 3

indication for prophylactic migraine therapy

Answer 3

frequent migraines ≥3 migraine headaches days per month
attacks interfere with daily living
contraindication, overuse, failure with acute tx

Question 4

Headache mneumonic for red flags

Answer 4

SNOOP
Systemic/secondary risk factors
Neuro sx
Onset - abrupt or with exertion
Onset - older (temporal/giant cell arteritis)
Prior HA hx, Positional (intracranial), Papilledema (encephalitis)

Question 5

Secondary HA examples

Answer 5

intracranial bleeding
increased ICP
meningitis
accelerated HTN
giant cell arteritis
tumor
viremic/sinusitis

Question 6

CT without contrast used for

Answer 6

acute or chronic hemorrhage

stroke

Question 7

CT with contrast used for

Answer 7

tumor, abscess

appendicitis/diverticulitis

Question 8

MRI used

Answer 8

tumors d/t better soft tissue imaging

Question 9

Migraine with aura sx

Answer 9

feeling of dread or anxiety
unusual fatigue
nervousness or excitement
GI upset
visual or olfactory alteration

Question 10

Initial test for Giant cell arteritis

Answer 10

Elevated ESR >100 mm/hr (autoimmune vasculitis of temporal artery) and CRP
follow up: arterial biopsy or ultra sound

Question 11

Tx for Giant cell arteritis

Answer 11

long-term high-dose systemic corticosteroid therapy, followed by taper 6 months - 2 years
aspirin to reduce stroke
PPI (GI) and bisphosphonate (bone protection)

Question 12

Most serious complication of giant cell arteritis

Answer 12

blindness

50% will have transient altered vision

Question 13

risk factor for giant cell arteritis

Answer 13

polymyalgia rheumatic (autoimmune diseases)
women 50-85 yrs old

Question 14

lifestyle to prevent headaches

Answer 14

regular sleep schedule
nutrition
hydration
exercise

Question 15

lifestyle triggers for migraines

Answer 15

menses/pregnancy
illness
intense activity
altered sleep/eating
bright/flickering lights
excessive/repetitive noises
odors/smoke
weather/high altitude
SSRI, SNRI, analgesic overuse, progestin with or without estrogen