Headache Management in Primary Care

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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?

They can lead to depression, lost productivity, and reduced quality of life. 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?

47% Signup and view all the answers

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

Headache is one of the most common presenting symptoms in primary care and represents a high proportion of patients referred to a neurology specialist. Signup and view all the answers

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

55% Signup and view all the answers

What is the maximum daily dose of eletriptan?

80 mg Signup and view all the answers

Which triptan is the only one that interacts with cimetidine?

Zolmitriptan Signup and view all the answers

What is the bioavailability of frovatriptan in women?

20% Signup and view all the answers

Which triptan has a higher oral bioavailability compared to sumatriptan?

Naratriptan Signup and view all the answers

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

Eletriptan Signup and view all the answers

What is the half-life of eletriptan?

The text does not provide the half-life of eletriptan. Signup and view all the answers

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

Naratriptan Signup and view all the answers

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

Rizatriptan Signup and view all the answers

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

All triptans Signup and view all the answers

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

Tension-type headache (TTH) 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?

Third Signup and view all the answers

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

Presence of specific features and associated symptoms Signup and view all the answers

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

Trigeminovascular system Signup and view all the answers

What is a common trigger for migraines?

Extreme fatigue Signup and view all the answers

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

Substance P and calcitonin gene-related peptides Signup and view all the answers

What is the gender prevalence difference in migraine cases?

Migraine is two to three times more prevalent in women than in men Signup and view all the answers

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

"Chronicity" or chronic nature of symptoms Signup and view all the answers

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

Excessive use of headache medications leading to rebound headaches Signup and view all the answers

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

Chronic migraine is treated differently than acute migraine with or without aura, using preventive therapies coupled with appropriate abortive pharmacological therapies. Signup and view all the answers

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

Triptans Signup and view all the answers

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

Antiemetics Signup and view all the answers

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

MAOIs Signup and view all the answers

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

Intravenous (IV) Signup and view all the answers

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

Opioids Signup and view all the answers

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

Dopamine receptor antagonists Signup and view all the answers

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

Patient preference for preventive therapy Signup and view all the answers

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

Both opioids and barbiturates Signup and view all the answers

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

Triptans 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?

Start with over-the-counter acetaminophen and/or NSAIDs and an antiemetic 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?

Escalate to a triptan and continue antiemetic Signup and view all the answers

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

Orally dissolving tablet or rectal 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?

They are the first step in the acute treatment of mild to moderate migraine without severe nausea or vomiting Signup and view all the answers

What is the recommended frequency for using abortive headache medications?

No more than twice a week 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?

Applying ice to the head and/or lying down in a darkened room 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?

Dependence and possible medication overuse Signup and view all the answers

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

It is contraindicated in patients with hypertension. Signup and view all the answers

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

They act selectively as 5-HT1 receptor agonists, resulting in vasoconstriction and inhibiting pain pathways. 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?

Rizatriptan Signup and view all the answers

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

Triptans should be taken at an early stage when pain is still mild, before central sensitization occurs. Signup and view all the answers

Which of the following statements about sumatriptan is true?

It is available in oral, subcutaneous, and intranasal forms. 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?

6 mg Signup and view all the answers

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

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. Signup and view all the answers

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

5-HT1D, 5-HT1B, and 5-HT1F Signup and view all the answers

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

1 to 3 hours Signup and view all the answers

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

It concluded that all of the available oral drugs are effective and well-tolerated. Signup and view all the answers

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

10 mg Signup and view all the answers

Why is ergotamine contraindicated in pregnancy?

It may cause prolonged uterine contractions Signup and view all the answers

Which category of pregnancy risk does ergotamine fall under?

Category X Signup and view all the answers

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

Vasoconstriction Signup and view all the answers

Which receptor do both ergotamine and dihydroergotamine bind to?

5HT-1b/d Signup and view all the answers

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

Nausea and vomiting Signup and view all the answers

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

Intravenously (IV) Signup and view all the answers

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

.5 - 1 mg Signup and view all the answers

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

To decrease nausea and vomiting 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?

Its synergistic effects when combined with an antiemetic Signup and view all the answers

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

ASA has antiprostaglandin and antiplatelet activity that may provide relief from migraine attacks. Signup and view all the answers

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

Ibuprofen in a liquid-filled capsule (Advil Migraine) 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?

4,000 mg per day Signup and view all the answers

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

550 mg Signup and view all the answers

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

Ketorolac Signup and view all the answers

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

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. 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?

Ergotamine has a high risk of adverse effects, such as nausea and vomiting. Signup and view all the answers

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

No NSAID has been found to be better than another in clinical trials. Signup and view all the answers

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

10 to 20 mg/kg/day divided in twice-daily dosing Signup and view all the answers