Headache

Question 1

1. Which of the following triptans would be appropriate for prevention of menstrual
   migraines?

A. Sumatriptan
B. Almotriptan
C. Frovatriptan
D. Elmotriptan

Answer 1

C

Question 2

2. Why should NSAIDs be avoided for headache in the third trimester of pregnancy?

A. Potential for teratogenicity
B. Premature closure of the ductus arteriosus
C. Induction of labor
D. All of the above

Answer 2

B

Question 3

3. Which of the following herbal medications might be effective at decreasing incidence of migraines?

A. Ginkgo biloba
B. Ginseng
C. Butterbur
D. Chromium

Answer 3

C

Question 4

4. Which of the following would be associated with an increased prevalence of migraine headache?

A. Low income
B. Female sex
C. Age > 30
D. All of the above

Answer 4

D

Question 5

5. Which of the following types of headache is least common?

A. Migraine
B. Tension
C. Cluster
D. Medication overuse headache

Answer 5

C

Question 6

6. Which of the following triptans should be recommended for patients who have
   nausea/vomiting associated with migraine headaches?

A. Zolmitriptan
B. Eletriptan
C. Almotriptan
D. Naratriptan

Answer 6

A

Question 7

7. How many headache days in a 1-month period must occur in order for a patient to be classified as having a chronic tension-type headache (TTH)?

A. 15
B. 4
C. 10
D. 7

Answer 7

A

Question 8

8. The pathogenesis of TTH is related to which of the following presumed mechanisms?

A. Muscle contraction
B. Hypoxemia
C. Hereditary factors
D. CNS pain sensitization

Answer 8

D

Question 9

9. Which of the following is a characteristic of a cluster headache?

A. Chronic daily pain
B. More common in men
C. Onset after age 50
D. Dull, band-like frontal pain

Answer 9

B

Question 10

10. A 20-year-old college sophomore presents to the student health department with the “worst headache of my life.” She provides a history of migraine headache treated with triptans. On physical examination, she is running a fever, her neck is stiffened, and a rash is noted. This type of headache disorder is classified as which of the following?

A. Treatment emergent
B. Primary
C. Secondary
D. Uncomplicated

Answer 10

C

Question 11

11. Which of the following is the most appropriate pharmacologic recommendation to treat severe nausea and vomiting in a headache patient?

A. High flow oxygen therapy
B. Oral opioid analgesics
C. Intramuscular chlorpromazine
D. Intravenous dihydroergotamine (DHE)

Answer 11

C

Question 12

12. Which of the following prophylactic treatments could potentially lead to the development of the “serotonin syndrome” in a patient prescribed naratriptan for migraine headache?

A. Timolol
B. Valproic acid
C. Topiramate
D. None of the above

Answer 12

D

Question 13

13. Serotonin receptor agonists (triptans) are available in all of the following dosage forms except:

A. Intranasal spray
B. Orally disintegrating tablet
C. Rectal suppository
D. Subcutaneous injection

Answer 13

C

Question 14

14. Which of the following therapeutic interventions would be most appropriate for the acute management of migraine without aura in a 54-year-old woman recently discharged from the coronary care unit (CCU) after an acute myocardial infarction (AMI)?

A. Intranasal sumatriptan
B. Oral acetaminophen and hydrocodone
C. Oral rizatriptan
D. Subcutaneous DHE

Answer 14

B

Question 15

15. Which of the following nonpharmacologic therapies is/are appropriate recommendation(s) for prevention of migraine headache?

A. Consistent sleep-wake cycle
B. Caffeine avoidance
C. Daily physical activity
D. All of the above

Answer 15

D

Question 16

1. Tension-type headache (TTH) are defined as _____ headaches in a 1-month period for
   _____ months.

A. 15 headaches; 6 months
B. 4 headaches; 3 months
C. 15 headaches; 2 months
D. 7 headaches; 9 months

Answer 16

A

Question 17

2. A 20-year-old college sophomore presents to the student health department with the “worst headache of my life.” She provides a history of migraine headache treated with triptans. On physical examination, she is running a fever, her neck is stiffened, and a rash is noted. This type of headache disorder is classified as which of the following?

A. Treatment emergent
B. Primary
C. Secondary
D. Uncomplicated

Answer 17

C

Question 18

3. Which of the following triptans would be appropriate for the prevention of menstrual migraines?

A. Sumatriptan
B. Almotriptan
C. Eletriptan
D. Frovatriptan

Answer 18

D

Question 19

4. Which of the following herbal medications might be effective at decreasing frequency of migraines?

A. Ginkgo biloba
B. Ginseng
C. Butterbur
D. Chromium

Answer 19

C

Question 20

5. The pathogenesis of TTH is related to which of the following presumed mechanisms?

A. Hypoxemia
B. Hereditary factors
C. CNS pain sensitization
D. Hormonal fluctuation

Answer 20

C

Question 21

6. Which of the following is only available in a quarterly dosing option for migraine
   prevention?

A. Eptinezumab-jjmr
B. Erenumab-aooe
C. galcanezumab-gnlm
D. fremanezumab-vfrm

Answer 21

A

Question 22

7. Triptans, like sumatriptan, should not be used concurrently with which of the following medications?

A. Ibuprofen
B. Ergotamine tartrate
C. Hydrocodone–acetaminophen
D. Aspirin

Answer 22

B

Question 23

8. A 34-year-old patient presents to the family medicine clinic with a severe headache pain that is associated with an aura. She presents a medication list containing the following: cimetidine, fexofenadine, alprazolam, and lisinopril.
   Which of her medications could be triggering her migraine?

A. Cimetidine
B. Fexofenadine
C. Alprazolam
D. Lisinopril

Answer 23

A

Question 24

9. Which of the following therapeutic interventions would be most appropriate for the acute management of migraine without aura in a 54-year-old woman recently discharged from the coronary care unit (CCU) after an acute myocardial infarction (AMI)?

A. Intranasal sumatriptan
B. Oral acetaminophen and hydrocodone
C. Oral rizatriptan
D. Subcutaneous DHE

Answer 24

B

Question 25

10. Which of the following would not be an appropriate treatment option for a 25-year-old pregnant patient with acute migraine? A. Rizatriptan B. Sumatriptan C. Almotriptan D. Naratriptan

Answer 25

C

Question 26

11. A concerned parent calls the pharmacy with questions about her son. She explains that her son is 7 years old and has been complaining of his head hurting for 2 hours. She has a history of migraine headaches and asks if it would be acceptable to give him a dose of sumatriptan. She also has ibuprofen, aspirin, and acetaminophen at home. Which medication would be the best option for this woman’s 7-year-old son? A. Sumatriptan B. Ibuprofen C. Aspirin D. Acetaminophen

Answer 26

B

Question 27

12. A 54-year-old man presents to the outpatient neurology clinic due to chronic daily headaches. The patient explains the pain steadily grows over hours until it is a 7/10 on the pain scale. He explains that, if left untreated, it lasts all day. He has a PMH of seasonal allergic rhinitis and asthma. Which of the following would not be an appropriate prophylactic treatment for this patient? A. Propranolol IR 40 mg PO BID B. Topiramate IR 50 mg PO BID C. Amitriptyline 25 mg PO QDay D. Metoprolol tartrate 50 mg PO QDay

Answer 27

A

Question 28

13. A 48-year-old man presents to the clinic complaining of “headaches so bad he would rather be dead.” He wants treatment but is worried about gaining weight. He has diabetes and dyslipidemia, and his doctor told him that losing weight would help him be better controlled. Which of the following medications would be the best choice for this patient? A. Valproic acid B. Divalproex sodium C. Amitriptyline D. Topiramate

Answer 28

D

Question 29

14. What is a key characteristic(s) that must be present to play a role in diagnosing a migraine headache? Select all that apply. A. An aura must be present. B. Pain worsens with physical activity. C. There is bilateral pain. D. Photophobia and phonophobia last 4 to 72 hours.

Answer 29

B, D

Question 30

15. A 62-year-old man with a history of migraine headaches is being discharged from the hospital following treatment for ischemic stroke. Which of the following medications would be least appropriate for abortive treatment of the patient’s migraines? A. Hydrocodone–acetaminophen B. Rimegepant C. Sumatriptan D. Acetaminophen

Answer 30

C