Beta Blockers for Migraine Prevention

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Questions and Answers

What is the maximum daily dose of propranolol in adults?

  • 240 mg (correct)
  • 120 mg
  • 200 mg
  • 160 mg

Which beta blocker has a level A recommendation for effectiveness in migraine prevention?

  • Pindolol
  • Atenolol
  • Nebivolol
  • Propranolol (correct)

What is the suggested starting dose range for propranolol in adults?

  • 20-40 mg/day
  • 60-80 mg/day (correct)
  • 40-60 mg/day
  • 80-100 mg/day

Which patient group should beta blockers be used cautiously in due to potential limitations?

<p>Patients with asthma (C)</p> Signup and view all the answers

What is the general timeline suggested for maintaining the dose of beta blockers before deeming the medication a failure?

<p>3 months (A)</p> Signup and view all the answers

What is the proposed mechanism of action of beta blockers in migraine prevention?

<p>Affecting the central catecholaminergic system and brain serotonin receptors (B)</p> Signup and view all the answers

What is the maximum recommended dose for propranolol in pediatric patients?

<p>0.5 to 1 mg/kg/d (A)</p> Signup and view all the answers

Which symptom suggests that the maximum dosage of a medication has been reached in adults?

<p>Pulse below 50 (A)</p> Signup and view all the answers

Why should pediatric patients be monitored closely when taking propranolol?

<p>To assess for side effects (A)</p> Signup and view all the answers

What is a common adverse effect of amitriptyline used for migraine prevention?

<p>Constipation (B)</p> Signup and view all the answers

Why is propranolol not recommended as the first-line drug in depressed patients?

<p>It can worsen depression (B)</p> Signup and view all the answers

Which condition is a contraindication for using propranolol?

<p>Chronic obstructive pulmonary disease (D)</p> Signup and view all the answers

What is the FDA indication for topiramate (Topamax) regarding migraine?

<p>Has an indication for migraine prophylaxis (C)</p> Signup and view all the answers

Which tricyclic antidepressant (TCA) may be used for migraine prevention and causes less drowsiness than amitriptyline?

<p>Nortriptyline (Pamelor) (C)</p> Signup and view all the answers

What is the recommended dosing strategy for NSAIDs in treating menstrual migraines?

<p>Start daily dosing a week before menses and continue for a week after (B)</p> Signup and view all the answers

Which of the following is a potential concern with the use of NSAIDs in older patients?

<p>Increased risk of nephrotoxicity or GI problems (B)</p> Signup and view all the answers

What is the level of evidence supporting the efficacy of calcium channel blockers for migraine prevention?

<p>The data are weak and conflicting (B)</p> Signup and view all the answers

What is the proposed mechanism by which calcium channel blockers may prevent migraine?

<p>Inhibiting vasospasm of the cerebral arteries and preventing cerebral hypoxia (D)</p> Signup and view all the answers

Which of the following is the most common calcium channel blocker used for migraine prevention?

<p>Verapamil (B)</p> Signup and view all the answers

What is the level of recommendation from AAN and AHS for the use of ACE inhibitors and angiotensin receptor blockers (ARBs) for migraine prevention?

<p>Level C recommendation (C)</p> Signup and view all the answers

Which of the following statements about botulinum toxin injection for migraine treatment is true?

<p>It is effective for chronic migraine but not episodic migraine (B)</p> Signup and view all the answers

What is the recommended dosing strategy for onabotulinumtoxinA (Botox) in the treatment of chronic migraine?

<p>An injection of 155 units in 31 sites divided across seven head and neck muscle areas, repeated every 12 weeks (A)</p> Signup and view all the answers

Which of the following is considered an important non-pharmacological management strategy for migraine?

<p>Identifying and avoiding migraine triggers (D)</p> Signup and view all the answers

What percentage of patients who seek alternative therapy for migraine never discuss it with their health-care provider?

<p>70% (A)</p> Signup and view all the answers

Which of the following is NOT recommended as a potential alternative therapy for migraine prevention?

<p>Chemotherapy (A)</p> Signup and view all the answers

What is a potential mechanism by which biofeedback may help relieve migraine symptoms?

<p>It modulates spontaneous discharge rates of cortical neurons (A)</p> Signup and view all the answers

Which of the following statements about transcranial direct current stimulation (tDCS) is TRUE according to the text?

<p>It shifts neuronal resting membrane potential, thereby modulating spontaneous discharge rates (C)</p> Signup and view all the answers

Based on the information provided, what can be inferred about the recommendation for butterbur as a treatment for migraine?

<p>It is no longer recommended due to safety and quality concerns (A)</p> Signup and view all the answers

What is the primary purpose of keeping a headache diary for migraine patients?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following statements about the PREMICE study is TRUE?

<p>All of the above (D)</p> Signup and view all the answers

Based on the information provided, which of the following statements about acupuncture for migraine treatment is TRUE?

<p>It is more effective than oral pharmacologic placebos (A)</p> Signup and view all the answers

Which of the following is a common food that can potentially trigger a migraine?

<p>Chocolate (C)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as a potential lifestyle change that may help prevent migraines?

<p>Regular exercise (B)</p> Signup and view all the answers

Which of the following alternative therapies has the strongest level of recommendation from the AAN and AHS?

<p>Vitamins and minerals like riboflavin, magnesium, and feverfew (A)</p> Signup and view all the answers

Which medication has been shown in studies to be effective in the management of tension-type headache (TTH)?

<p>All of the above (D)</p> Signup and view all the answers

What is the recommended daily dosage of gabapentin for the treatment of tension-type headache?

<p>2,400 mg (B)</p> Signup and view all the answers

Which of the following nonpharmacological therapies is NOT mentioned in the text as helpful for the preventive treatment of tension-type headache?

<p>Cognitive-behavioral therapy (D)</p> Signup and view all the answers

What is the primary purpose of keeping a headache diary for patients with tension-type headache?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following statements about new daily persistent headache (NDPH) is NOT true according to the text?

<p>It is typically diagnosed in individuals with a prior history of migraine or tension-type headache (D)</p> Signup and view all the answers

What is the minimum duration of headache required for the diagnosis of new daily persistent headache (NDPH)?

<p>3 months (B)</p> Signup and view all the answers

Which of the following therapies is NOT mentioned in the text as a potential treatment option for tension-type headache?

<p>Transcranial magnetic stimulation (B)</p> Signup and view all the answers

What should be the frequency of monitoring for the effectiveness of acute or preventive medication prescribed for tension-type headache at the beginning of treatment?

<p>Every 1 to 2 months (B)</p> Signup and view all the answers

Which of the following is NOT mentioned in the text as an important aspect of patient education for the treatment of tension-type headache?

<p>Potential side effects of medications (C)</p> Signup and view all the answers

What is the primary reason for monitoring the use of combination drugs like butalbital and isometheptene compounds in the treatment of tension-type headache?

<p>To safeguard against potential medication overuse headache developing from overuse (A)</p> Signup and view all the answers

What is the defining characteristic of New Daily Persistent Headache (NDPH)?

<p>Sudden onset of daily headache (A)</p> Signup and view all the answers

What are the two subtypes of NDPH mentioned in the text?

<p>Self-limiting and refractory (B)</p> Signup and view all the answers

Which of the following is true about the incidence and prevalence of NDPH?

<p>The incidence and prevalence in the general population are unknown (B)</p> Signup and view all the answers

Which of the following viruses has been studied in relation to the potential etiology of NDPH?

<p>Epstein-Barr virus (A)</p> Signup and view all the answers

What is the proposed pathogenesis of NDPH according to the text?

<p>Persistent inflammation in the nervous system (D)</p> Signup and view all the answers

Which of the following statements about the treatment of NDPH is true according to the text?

<p>The best approach is to manage symptoms based on chronicity and severity (A)</p> Signup and view all the answers

Which of the following medications has been recommended for the pharmacological treatment of NDPH?

<p>Amitriptyline (D)</p> Signup and view all the answers

What is the recommended approach for monitoring patients with primary NDPH according to the text?

<p>Monitor for efficacy of therapy, side effects, and refractory symptoms (C)</p> Signup and view all the answers

What should be done if a suspected primary NDPH fails to improve with treatment?

<p>Consider the possibility of a secondary headache and refer for further evaluation (A)</p> Signup and view all the answers

What is recommended in the text regarding patient tracking of symptoms and treatment outcomes for NDPH?

<p>Patients should track symptoms and treatment outcomes, as the therapeutic window might be narrow (B)</p> Signup and view all the answers

What is the primary focus of patient education for treating NDPH?

<p>Emphasizing the biological origin of the disorder and the importance of avoiding medication overuse (D)</p> Signup and view all the answers

What is the key message regarding the use of nonpharmacological therapies in the treatment of NDPH?

<p>Nonpharmacological therapies should be used to complement pharmacological treatments. (A)</p> Signup and view all the answers

What is the primary reason for closely monitoring patients with NDPH for mood alterations?

<p>To determine if the patient is experiencing prolonged and refractory symptoms (C)</p> Signup and view all the answers

Which of the following is NOT a key aspect of patient education for NDPH?

<p>Providing information about the general timeline for maintaining the dose of beta blockers (B)</p> Signup and view all the answers

What is the primary role of patient education in the treatment of NDPH?

<p>To ensure the patient understands the overall treatment plan and adheres to the prescribed drug therapy (B)</p> Signup and view all the answers

Which of the following medications requires patients to have their liver function and complete blood count (CBC) tested every 2 weeks for a total of 6 weeks?

<p>Divalproex (C)</p> Signup and view all the answers

What is the primary goal of migraine treatment according to the passage?

<p>To minimize the impact of migraine headaches on patients' quality of life, social functioning, and ability to work (D)</p> Signup and view all the answers

How is the success of preventive therapy for frequent migraine sufferers evaluated?

<p>Both b and c (B)</p> Signup and view all the answers

What is the recommended approach for patients who are unable to determine if a specific item is a migraine trigger?

<p>Eliminate the item from their diet for 2 weeks and then reintroduce it (B)</p> Signup and view all the answers

What is the recommended treatment duration before changing the regimen for preventive therapy in frequent migraine sufferers?

<p>2 to 3 months (A)</p> Signup and view all the answers

Which of the following is a characteristic of tension-type headaches (TTH) according to the passage?

<p>Bilateral, persistent, and dull pain (C)</p> Signup and view all the answers

What is the recommended approach for patients to have a rescue strategy in place for acute migraines?

<p>All of the above (D)</p> Signup and view all the answers

According to the passage, what is the lifetime prevalence range of tension-type headaches (TTH) in the general population?

<p>30% to 78% (D)</p> Signup and view all the answers

What is a key difference between migraine and tension-type headaches (TTH) mentioned in the passage?

<p>Migraine is worsened by physical activity, while TTH is not (A)</p> Signup and view all the answers

What is the recommended approach for patients who are unable to identify their migraine triggers?

<p>Eliminate one item at a time from the common triggers list and monitor for improvements (A)</p> Signup and view all the answers

What is the primary goal of treatment for tension-type headaches?

<p>Decrease headache frequency and severity (B)</p> Signup and view all the answers

Which neurotransmitters are modulated by TCAs to reduce the incidence of tension-type headaches?

<p>Serotonin and norepinephrine (A)</p> Signup and view all the answers

Why should preventive therapy be considered for tension-type headache patients with increased frequency and disability?

<p>To prevent medication overuse headaches (MOH) (B)</p> Signup and view all the answers

What role does nitric oxide (NO) play in the pathophysiology of tension-type headaches?

<p>Key role (C)</p> Signup and view all the answers

Which medications have shown limited evidence for use in chronic tension-type headaches without any related harmful effects?

<p>Topiramate and gabapentin (D)</p> Signup and view all the answers

What is the plausible reason behind the shift towards parenteral therapies like ketorolac in treating tension-type headaches?

<p>Superiority over placebo shown in low-quality trials (D)</p> Signup and view all the answers

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