CC Nov 2017 Migraine headache

echoecho's version from 2017-11-27 16:55


Question Answer
Migraine is the most common recurrent headache disorder, affecting an estimated ___% of US adult?15%
Among preadolescent children, what gender are more frequently affects, however, migraines are 3 times more common in what adult gender?1) boys 2) women
True of false? A positive family hx of migraines is commonly found?True
Symptom onset occurs before age _____ in 75% of migraineurs?35
Migraines is diagnosed by clinical _____; knowledge of its epidemiology and typical symptoms enables family physicians to aprovide appropriate counseling and treatment, while minimizing unnecessary diagnostic testing?Criteria
The Internationbal Headache Society has published distinct diagnostic criteria for what two categories?1) migraine with aura 2) migrain without aura
An estimated ____% of migraine patients experience auras immediately prior to or during headaches?30%
List the most common auras?1) visual symptoms such as scotomata (focal visual defects) 2) flashes of light or geometric designs
List the less common auras?1) speech disturbances 2) paresthesia 3) olfactory hallucinations 4) focal weakness
In migraine patients without aura (the majority), what is the duration of an acute attack?4-72 hours
List the typical characteristics of a migraine?1) typically unilateral 2) pulsating in quality 3) photophobia 4) photophobia 5) nausea
One review found that the presence of at least ____ of the 5 "POUND" criteria was associated with a 92% likelihood for the diagnosis of migraine, 64% for those with 3 criteria and 17% for those with < 2 criteria?4
List the POUND criteria?1) Pulsatile quality of headache 2) One-day duration (4-72 hours) 3) Unilateral location 4) Nausea or vomiting 5) Disabling intensity
What other causes of headache should be considered?1) acute glaucoma 2) temporal arthritis 3) hypertensive crisis 4) intracranial pathology
A careful neurologic exam should be performed in all patients presenting with headache, why?because a focal neurologic abnormality, abrupt onset and age > 50 all increase the probability of a CNS lesion
Once a diagnosis of migraine has been established, what should be done?effort to identify potential triggers and make appropriate lifestyle modifications
What is the most important dietary trigger?delayed or missed meal
Specific foods can also trigger migraines, what should be done to help patient identify possible triggers and to make appropriate dietary modifications?keep a headache diary
In addition, migraines are associated with smoking, insomnia, and obesity, true or false?true
It is unclear whether insomnia causes migraines or vice versa, small randomized trials have shown what?that behavioral treatments for insomnia can improve migraine symptoms
What other hormonal changes can trigger migraines?1) menstrual cycle 2) menopaus 3) hormonal contraceptives / medications
What are the acute treatments for migraine attacks?1) both non-specific analgesics and migraine-specific medications 2) many patients experience relief from rest in a quiet, dark room
***Abortive treatment for migraine attacks should be initiated at the earliest onset of symptoms. What are the guidelines according to the American Headache Society?1) NSAIDs are recommended as first-line treatment for mild to moderate migraine headaches 2) combination analgesics containing ASA, caffeine and acetaminophen (Excedrin Migraine) are an effective first-line abortive treatment for migraine 3) Triptans are recommended as first-line therapy for moderate to severe acute attacks
Injectable, transdermal or intranasal formulations of triptans are appropriate for what type of patient?in those whose headache-associated nausea limits the ability to use oral medication
What formulations is DHE (dihydroergotamine) is available for migraine treatment as a second-line treatment?injectable and nasal formulations
Why are DHE and triptans contraindicated in patients with established or suspected vascular disease?these two medications are vasoconstrictors
Although butalbital was often used in the past, alone or combination products, is there evidence to support its effectiveness for acute migraines?no
*** What is MOH?medication overuse headache in which excessive acute headache medications causes a chronic headache syndrome. It is suspected in patients who use headache medications more than 10 days per month
What is the treatment of MOH?1) cessation of the offending medication 2) may require 4 weeks for resolution of symptoms depending on the specific agent
When is prophylactic therapy considered?1) patients with frequent acute attacks 2) overuse of abortive treatment (more than twice per week) 3) adverse effects or unsatisfactory response to acute treatment
**** According to a guidline developed by the American Academy of Neurology and the American Headache Society, evidence supports the use of what medications for migraine prevent? In addition, the short-term use of what medication is used for prevention of menstrual-related migraines?1) Valproic acid (Depakene) 2) topiramate (Topamax) 3) propranolol (Internal) 4) Metoprolol (Lopressor) 5) short term use of frovatriptan (Frova) for prevention of menstrual -related migraines
List medications that were classified as having level B evidence (probably effective, may be considered for use)?1) Amitriptyline 2) Venlafaxine 3 ) Nadolol 4) Atenolol
How are preventive medications titration and for how long should they be used before clinical benefit is realized?1) gradually titration to a target dose 2) use 2-3 months before clinical benefit is realized
*** A 2016 Cochran review showed moderate evidence that acupuncture treatment is as effective as prophylactic medications, so a series of _____ acupuncture treatments may be considered for prevention of migraines?6
Define chronic migraine?as having 15 headache days a month for > 3 months and is a subset of migraine patients (about 1-2% of the general population) whose symptoms are disabling
What is the treatment for chronic migraines?multifactorial (including lifestyle modification and trigger reduction, stress management and both acute and preventive therapies) and referral to a headache specialist for treatment such as botulinum toxin injections
Some observational studies have noted a link between what heart disease and migraines. What were the outcomes of 3 different randomized trials?1) PFO (patent foramen ovale) 2) closure of the PFO failed to show reduction in the frequency or severity of migraines
*** SUMMARY = What is the most common recurrent headache disorder?migraines
*** SUMMARY = The diagnosis is made how?1) clinical 2) following a carefully hx and physical exam
*** SUMMARY = Acute attacks are treatment with _____ or ______, if severe?NSAIDs; triptans
*** SUMMARY = List medications that are effective for prevention of frequent attacks?propranolol and topiramate