Medication Overuse Headache (MOH) Criteria

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According to the ICHD-3 criteria, what is the minimum number of days per month that a patient must have headache to be diagnosed with MOH?

10 days

25 days

20 days

15 days (correct)

What is the estimated percentage of chronic migraine patients that overuse acute analgesics, according to the text?

70% (correct)

90%

30%

50%

What does the text state is among the costliest of all headache disorders?

Chronic migraine

Cluster headache

Tension-type headache

Medication overuse headache (MOH) (correct)

Which of the following is NOT a characteristic of MOH?

It has a specific gender preference Signup and view all the answers

What does the text state is reassuring to the provider, but not always initially to the patient?

A thorough history and physical examination with negative findings other than medication use Signup and view all the answers

Which of the following medications can put patients at increased risk of a co-occurring compounded headache scenario?

All of the above Signup and view all the answers

What are the first choices for prevention medication in posttraumatic situations?

Antidepressants Signup and view all the answers

Which medication can be used as a first-line therapy for migraines?

Verapamil Signup and view all the answers

When can IV DHE be effective for severe PTH?

After 1 or 2 months Signup and view all the answers

Which medication has shown positive results in preliminary studies for patients with more severe TBI?

Donepezil Signup and view all the answers

What belief at the time of injury was correlated with enduring symptoms at 3 months in patients with mild TBI?

'Long-lasting negative effects' as a probable outcome Signup and view all the answers

What should patient education for post-concussive syndrome include?

A discussion of information related to the overall treatment plan and specific drug therapy Signup and view all the answers

What is the timeframe within which headaches may worsen after stopping medication in cases of MOH?

72 hours Signup and view all the answers

Which strategy is emphasized to reduce the incidence of relapse in patients with MOH?

Education about and trial of effective preventive therapy Signup and view all the answers

What is a common consequence seen in patients with posttraumatic headache (PTH)?

Reduced ability to concentrate Signup and view all the answers

How long may headaches persist in patients with posttraumatic headache (PTH) after a more severe trauma?

Lifetime Signup and view all the answers

What feature distinguishes a primary posttraumatic headache (PTH) from a secondary headache category?

'Fulfilling all of the diagnostic criteria' Signup and view all the answers

What is the suspected pathogenesis of posttraumatic headache (PTH)?

'Psychogenic mechanisms' Signup and view all the answers

In what timeframe should a headache develop after trauma as per the diagnostic criteria for posttraumatic headache (PTH)?

'Within 7 days' Signup and view all the answers

What proportion of reported traumatic brain injuries in the military result from blast exposures?

'75%' Signup and view all the answers

What fraction of athletes in the United States are estimated to sustain traumatic brain injuries (TBIs)?

'1.6 to 3.8 million athletes' Signup and view all the answers

'Education about, and an adequate trial of, an effective preventive therapy' is emphasized in which type of headache management?

'Posttraumatic Headache (PTH)' Signup and view all the answers

What is one common contributing factor to the diagnosis and management of post-traumatic headache (PTH)?

Post-dural puncture resulting in a chronic 'low-flow' dural leak Signup and view all the answers

How is the severity of traumatic brain injury (TBI) categorized based on the Glasgow Coma Scale?

Mild (score: 13 to 15), moderate (score: 9 to 12), or severe (score: less than 9) Signup and view all the answers

What are some symptoms of mild to moderate traumatic brain injury (TBI) according to the text?

Headaches, dizziness, nausea, and amnesia Signup and view all the answers

What are some common symptoms that often accompany the post-traumatic headache (PTH) syndrome according to the text?

Dizziness or vertigo, tinnitus, and irritability Signup and view all the answers

What is recommended for early treatment of post-traumatic headache (PTH)?

Neuromodulation of pain with prophylactic agents Signup and view all the answers

Which mineral has demonstrated neuroprotective properties in numerous traumatic brain injury (TBI) models?

Magnesium Signup and view all the answers

What are some beneficial effects of magnesium mentioned in relation to traumatic brain injury?

Noncompetitive N-methyl-D-aspartate receptor blockade Signup and view all the answers

'Nicotinamide' belongs to which group of vitamins according to the text?

'B-group' vitamin Signup and view all the answers

'Glutamate excitotoxicity', a key pathological sequelae of concussion, is associated with:

(AMPA) receptor activation Signup and view all the answers

What is the typical daily dosage range of amitriptyline used for posttraumatic tension-type headaches (PTH)?

25 to 100 mg Signup and view all the answers

Which treatment approach has been shown to provide relief for refractory chronic PTH?

Inpatient treatment of IV dihydroergotamine and metoclopramide Signup and view all the answers

What percentage of patients with posttraumatic headaches responded favorably to analgesic withdrawal, similar to patients whose headaches were not posttraumatic?

19% to 42% Signup and view all the answers

Which of the following medications has been used to treat sleep disturbances after concussion?

Melatonin Signup and view all the answers

Which of the following medications has NOT been discussed as a potential medical therapy for persistent headaches after concussion?

Opioids Signup and view all the answers

What is the primary goal of preventive therapy for posttraumatic headaches?

To use the least amount of medication with the fewest side effects to decrease migraine symptoms Signup and view all the answers

If medication overuse is suspected in a patient with posttraumatic headaches, what should be done before starting preventive therapy?

Treat the medication overuse first before starting preventive therapy Signup and view all the answers

Which of the following medications are commonly used as preventive therapy for posttraumatic headaches?

Antidepressants and beta blockers Signup and view all the answers

In severe cases of posttraumatic headaches, what combination of medications is recommended for preventive therapy?

Beta blocker and antidepressant Signup and view all the answers

Which statement is correct regarding the selection of preventive medication for posttraumatic headaches?

The selection of preventive medication differs depending upon which headache type is predominant Signup and view all the answers

What is the suggested regimen for the phenobarbital taper during butalbital withdrawal?

30 mg of phenobarbital per day for every 100 mg of butalbital that was being used, tapering by 30 mg every 2 to 3 days Signup and view all the answers

What is the recommended treatment for opioid withdrawal symptoms during butalbital withdrawal?

Administer a once-weekly transdermal clonidine patch (0.1 to 0.2 mg/24 hours) for 1 to 2 weeks Signup and view all the answers

What is the recommended bridge therapy to accompany the withdrawal of butalbital and opioids?

A combination of the above therapies Signup and view all the answers

What is the recommended approach to discontinuing butalbital and opioid medications during an acute care setting?

Abruptly discontinue butalbital, but taper opioids if high doses were being used Signup and view all the answers

What is the recommended approach to monitoring the patient after successful detoxification from butalbital and opioids?

Closely monitor the patient's use of acute relief medications and preventive therapy Signup and view all the answers

What is the recommended approach to patient education during the butalbital and opioid withdrawal process?

Educate the patient on the overall treatment plan, including the drug therapy and adherence issues Signup and view all the answers

What is the recommended approach to preventing overuse of acute relief medications after the withdrawal process?

Closely monitor the number of doses of acute relief medication the patient is allowed to have each month Signup and view all the answers

What is the recommended approach to initiating or optimizing preventive therapy after the withdrawal process?

Preventive therapy should be initiated or optimized to accompany the withdrawal of butalbital and opioids Signup and view all the answers

How long does it typically take for the patient to show improvement in headaches after the withdrawal process?

8 to 12 weeks Signup and view all the answers

Which of the following is NOT a criteria for medication overuse headache (MOH)?

Headache better accounted for by another ICHD-3 diagnosis Signup and view all the answers

Which type of medication is less likely to cause medication overuse headache?

Triptans Signup and view all the answers

What is the goal of treating medication overuse headache?

To reset the typical headache pattern by discontinuing the overused analgesics Signup and view all the answers

Which of the following is NOT a factor postulated to play a role in the mechanisms leading to medication overuse headache?

Excessive caffeine intake Signup and view all the answers

Which of the following medications should be used with caution during the withdrawal period for medication overuse headache?

Naproxen Signup and view all the answers

What is the recommended approach for withdrawing from butalbital-containing drugs in medication overuse headache?

Slow taper over 2-4 weeks Signup and view all the answers

Which of the following is NOT a potential complication of abrupt withdrawal from butalbital-containing drugs?

Severe headache Signup and view all the answers

What is the recommended initial dose of tizanidine for managing withdrawal symptoms during medication overuse headache?

2 mg at bedtime Signup and view all the answers

Which of the following statements is TRUE regarding the use of preventive therapy in medication overuse headache?

Preventive therapy can be started before, during, or after the withdrawal process Signup and view all the answers

What is the recommended approach for consulting a specialist in the management of medication overuse headache?

Consult a neurologist or headache specialist before embarking on detoxification Signup and view all the answers

Which of the following agents has shown neuroprotective effects in an animal model by reducing inflammatory markers, preserving blood-brain barrier permeability, and reducing brain edema?

-lipoic acid Signup and view all the answers

Which of the following statements is true regarding the use of progesterone in the treatment of traumatic brain injury (TBI)?

A Phase III clinical trial called ProTECT III is currently underway to assess the clinical efficacy of progesterone in TBI. Signup and view all the answers

Which of the following statements is true regarding erythropoietin (EPO) in the treatment of TBI?

EPO administration was associated with a potential differential improvement in 6-month mortality in TBI patients with more severe extracranial injury, but these findings need additional confirmation. Signup and view all the answers

Which of the following statements is true regarding minocycline in the treatment of TBI?

Minocycline has been extensively studied in mice and has been shown to be an effective antioxidant and attenuator of the inflammatory sequelae of TBI. Signup and view all the answers

Based on the information provided in the text, which of the following statements is true regarding cyclosporin A (CsA) in the treatment of TBI?

The safety of CsA use in TBI has been demonstrated, but additional investigation is needed to clarify the efficacy of the drug. Signup and view all the answers

Which of the following statements is true regarding the use of medications in the treatment of TBI?

Medication management tends to be the cornerstone of treatment, but the role of behavioral management and support is gaining recognition for its importance as the psychological impact of TBI is better understood. Signup and view all the answers

Which of the following statements is true regarding the use of abortive and preventive medications in the treatment of TBI-related headaches?

Abortive medications are recommended for the first 3 weeks of headaches, and preventive medications are recommended if the headaches persist beyond this point and remain moderate or severe. Signup and view all the answers