Headache Management in Primary Care

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Questions and Answers

According to the information provided, which of the following types of headaches is classified as a primary headache disorder by the International Classification of Headache Disorders (ICHD-3)?

  • Migraine
  • Cluster headache
  • Tension-type headache (TTH)
  • All of the above (correct)

What is the approximate global percentage of the adult population with an active tension-type headache (TTH) disorder, according to the information provided?

  • 5%
  • 10%
  • Up to 70% (correct)
  • 47%

According to the information provided, which of the following statements is true regarding the disability attributable to tension-type headache (TTH) compared to migraine?

  • The disability attributable to migraine is greater worldwide than that due to TTH.
  • The disability attributable to TTH and migraine is equal worldwide.
  • The disability attributable to TTH is greater worldwide than that due to migraine. (correct)
  • There is no information provided about the disability attributable to TTH or migraine.

Which of the following statements is true about poorly managed chronic headaches, according to the information provided?

<p>They can lead to depression, lost productivity, and reduced quality of life. (D)</p> Signup and view all the answers

According to the information provided, what is the approximate global percentage of the adult population with an active headache disorder in general?

<p>47% (A)</p> Signup and view all the answers

Which of the following statements is true about headaches in primary care, according to the information provided?

<p>Headache is one of the most common presenting symptoms in primary care and represents a high proportion of patients referred to a neurology specialist. (A)</p> Signup and view all the answers

What percentage of study subjects reported pain relief from their migraine when administered 6.25 mg of almotriptan?

<p>55% (B)</p> Signup and view all the answers

What is the maximum daily dose of eletriptan?

<p>80 mg (A)</p> Signup and view all the answers

Which triptan is the only one that interacts with cimetidine?

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

What is the bioavailability of frovatriptan in women?

<p>20% (B)</p> Signup and view all the answers

Which triptan has a higher oral bioavailability compared to sumatriptan?

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

Which triptan is a second-generation triptan, approved by the FDA in 2002?

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

What is the half-life of eletriptan?

<p>The text does not provide the half-life of eletriptan. (B)</p> Signup and view all the answers

Which triptan is recommended to be dosed lower when taken concurrently with oral contraceptives?

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

Which triptan has a higher oral bioavailability compared to sumatriptan, but not as high as naratriptan?

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

Which triptan is contraindicated in patients with coronary artery disease or uncontrolled hypertension?

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

Which primary headache disorder is indicated to have the greatest disability worldwide?

<p>Tension-type headache (TTH) (C)</p> Signup and view all the answers

In the Global Burden of Disease Study 2015, what was the ranking of migraine among causes of disability worldwide?

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

What is the distinguishing feature between migraine without aura and migraine with aura?

<p>Presence of specific features and associated symptoms (A)</p> Signup and view all the answers

Which of the following systems is implicated in the pathophysiology of migraine?

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

What is a common trigger for migraines?

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

Which neurotransmitters are released due to changes in serotonin activity in migraine?

<p>Substance P and calcitonin gene-related peptides (C)</p> Signup and view all the answers

What is the gender prevalence difference in migraine cases?

<p>Migraine is two to three times more prevalent in women than in men (A)</p> Signup and view all the answers

"Chronic migraine" is primarily defined based on what characteristic?

<p>&quot;Chronicity&quot; or chronic nature of symptoms (A)</p> Signup and view all the answers

"Medication-overuse headache" refers to headaches caused by:

<p>Excessive use of headache medications leading to rebound headaches (B)</p> Signup and view all the answers

What kind of therapies are used for chronic migraine compared to acute migraine?

<p>Chronic migraine is treated differently than acute migraine with or without aura, using preventive therapies coupled with appropriate abortive pharmacological therapies. (B)</p> Signup and view all the answers

What should be avoided if ergotamine derivatives have been used in the previous 24 hours?

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

Which medications are used in the management of acute migraine headache?

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

What should be avoided when using triptans according to the text?

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

Which route of antiemetic administration may be important for patients with nausea and vomiting during acute migraine?

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

What is NOT recommended for migraine management even in the acute phase?

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

What is the mechanism of action of intravenous metoclopramide, chlorpromazine, and prochlorperazine used in acute migraine headache?

<p>Dopamine receptor antagonists (A)</p> Signup and view all the answers

Which of the following is NOT a general criterion for starting preventive therapy for migraine?

<p>Patient preference for preventive therapy (D)</p> Signup and view all the answers

Which of the following medications should NOT be used for the treatment of migraine?

<p>Both opioids and barbiturates (C)</p> Signup and view all the answers

Which of the following is the mainstay of acute migraine treatment according to the text?

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

If a patient is experiencing nausea with their migraine attack, what is the recommended initial treatment approach according to the text?

<p>Start with over-the-counter acetaminophen and/or NSAIDs and an antiemetic (B)</p> Signup and view all the answers

If the initial treatment approach does not provide pain relief within 2 hours and freedom from pain for 24 hours, what is the next recommended step according to the text?

<p>Escalate to a triptan and continue antiemetic (A)</p> Signup and view all the answers

What route of administration should be considered for a patient who has been vomiting during their migraine attack?

<p>Orally dissolving tablet or rectal (A)</p> Signup and view all the answers

Which of the following statements about simple analgesics (e.g., aspirin, acetaminophen, NSAIDs) is TRUE according to the text?

<p>They are the first step in the acute treatment of mild to moderate migraine without severe nausea or vomiting (B)</p> Signup and view all the answers

What is the recommended frequency for using abortive headache medications?

<p>No more than twice a week (D)</p> Signup and view all the answers

Which of the following nonpharmacological therapies is recommended to accompany the medication treatment for acute migraine attacks, according to the text?

<p>Applying ice to the head and/or lying down in a darkened room (C)</p> Signup and view all the answers

Which of the following is a potential consequence of even short-term use of opioids or barbiturates for migraine treatment?

<p>Dependence and possible medication overuse (D)</p> Signup and view all the answers

Which of the following statements about dihydroergotamine (DHE) is true?

<p>It is contraindicated in patients with hypertension. (A)</p> Signup and view all the answers

How do serotonin receptor agonists (triptans) work to treat migraines?

<p>They act selectively as 5-HT1 receptor agonists, resulting in vasoconstriction and inhibiting pain pathways. (D)</p> Signup and view all the answers

Which of the following triptans was found to have the highest likelihood of consistent success in a meta-analysis of over 24,000 patients?

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

What was the key finding of the Act when Mild (AwM) study regarding the timing of triptan administration?

<p>Triptans should be taken at an early stage when pain is still mild, before central sensitization occurs. (D)</p> Signup and view all the answers

Which of the following statements about sumatriptan is true?

<p>It is available in oral, subcutaneous, and intranasal forms. (A)</p> Signup and view all the answers

According to the Cochrane review of subcutaneous sumatriptan, what dose was found to be significantly better than 4 mg for pain-free at 1 hour?

<p>6 mg (C)</p> Signup and view all the answers

Which of the following statements about oral sumatriptan is true, according to the Cochrane review?

<p>The 100-mg dose was significantly better than the 50-mg dose for pain-free and headache relief at 2 hours, and for sustained pain-free for 24 hours. (B)</p> Signup and view all the answers

Which of the following serotonin receptor subtypes does almotriptan bind to with high affinity?

<p>5-HT1D, 5-HT1B, and 5-HT1F (B)</p> Signup and view all the answers

What is the typical peak absorption time for almotriptan after administration?

<p>1 to 3 hours (A)</p> Signup and view all the answers

Which of the following statements about the meta-analysis of oral serotonin agonists is true?

<p>It concluded that all of the available oral drugs are effective and well-tolerated. (D)</p> Signup and view all the answers

What is the maximum total weekly dose of ergotamine allowed to prevent medication-overuse headaches?

<p>10 mg (C)</p> Signup and view all the answers

Why is ergotamine contraindicated in pregnancy?

<p>It may cause prolonged uterine contractions (D)</p> Signup and view all the answers

Which category of pregnancy risk does ergotamine fall under?

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

What is one serious effect of ergotamine in patients with peripheral vascular disease?

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

Which receptor do both ergotamine and dihydroergotamine bind to?

<p>5HT-1b/d (C)</p> Signup and view all the answers

What is a common side effect of ergotamine that limits its routine use?

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

Which route of administration is generally restricted to the emergency department or hospital setting for DHE 45?

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

What is the recommended initial dosage of parenteral DHE 45 for acute migraine?

<p>.5 - 1 mg (D)</p> Signup and view all the answers

Why is pretreatment with an antiemetic recommended before using DHE 45?

<p>To decrease nausea and vomiting (D)</p> Signup and view all the answers

'Studies have shown that the combination of parenteral DHE 45 with an antiemetic is superior in terms of migraine control than DHE 45 alone' - Which aspect about DHE 45 does this statement emphasize?

<p>Its synergistic effects when combined with an antiemetic (A)</p> Signup and view all the answers

What is the primary mechanism of action for aspirin (ASA) in the treatment of migraine?

<p>ASA has antiprostaglandin and antiplatelet activity that may provide relief from migraine attacks. (C)</p> Signup and view all the answers

Which OTC medication has been approved by the FDA specifically for the treatment of migraine pain?

<p>Ibuprofen in a liquid-filled capsule (Advil Migraine) (D)</p> Signup and view all the answers

What is the maximum daily dose of aspirin (ASA) or acetaminophen (APAP) recommended for the treatment of migraine symptoms?

<p>4,000 mg per day (C)</p> Signup and view all the answers

What is the recommended starting dose of naproxen sodium (Anaprox, Aleve) for the treatment of migraine?

<p>550 mg (D)</p> Signup and view all the answers

Which of the following is the only NSAID available in an injectable form for the treatment of migraine?

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

What is the primary mechanism of action for ergotamine and dihydroergotamine (DHE 45) in the treatment of migraine?

<p>They act as vasoconstrictors that lead to a decline in the amplitude of pulsation in the extracranial arteries and decreased hyperperfusion of the basilar artery area. (B)</p> Signup and view all the answers

What is the primary reason for the limited routine use of ergotamine in the treatment of acute migraine attacks?

<p>Ergotamine has a high risk of adverse effects, such as nausea and vomiting. (C)</p> Signup and view all the answers

Which of the following statements is true about the use of NSAIDs in the treatment of migraine?

<p>No NSAID has been found to be better than another in clinical trials. (D)</p> Signup and view all the answers

What is the recommended dosing for naproxen sodium (Anaprox, Aleve) in pediatric patients for the treatment of migraine?

<p>10 to 20 mg/kg/day divided in twice-daily dosing (C)</p> Signup and view all the answers

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