Headaches Quiz Flashcards
(11 cards)
Match each type of headache with its symptoms.
Tension
Cluster
Migraine
A) Unilateral, severe, sharp pain with ipsilateral cranial autonomic symptoms
B) Bilateral, mild to moderate pressure, band like sensation, radiating pain to neck/occipital region
C) Unilateral, throbbing pain, light and noise sensitivity
Tension – B
Cluster – A
Migraine – C
Ibuprofen MOA
NSAID; COX-1 and COX-2 inhibitors
Morphine MOA
Mu-opiate receptor agonist
Sumatriptan MOA
Selective serotonin 5-HT1B and 5-HT1D receptor agonist
Ergotamine tartrate MOA
Non-selective 5-HT1 receptor agonist
Triptans and ergot alkaloids are contraindicated in patients with all of the following medication problems except:
A) Uncontrolled HTN
B) Cerebrovascular disease
C) CAD
D) Diabetes
D
Which of the following is not an example of when migraine prophylaxis is indicated?
A) A patient who experiences mild migraines two times a month that responds well to NSAIDs
B) A patient who experiences moderate migraines (once a month) and has uncontrolled HTN and a history of GI bleed excluding her from treatment with triptans and NSAIDs
C) A patient who experiences severe migraines several times per week requiring treatment with a triptan
D) A patient who experiences a moderate migraine every month during her menstrual cycle that causes her to miss several days of work
A
“The medications YOU prescribed don’t work, they are very expensive, and I have gained 10 pounds!” Today’s patient a 30 Y/O F returns to clinic for a follow-up re her Migraine headaches. The frequency (4-5/month) and severity (7/10) of her migraines has increased since her return to full time employment. Migraines usually start in the morning, and are more frequent around her menses. They are associated with nausea, and photophobia. At her last visit (3 months ago) you advised her to stop taking Cafergot, and prescribed naratriptan 2.5 mg at the onset of migraine, and valproic acid for migraine prophylaxis. The naratriptan works about 50% of the time for her, but it always takes too long to start acting. A) Which medication is most likely associated with her weight gain, and B) when could she repeat the dose of naratriptan and how many doses per day could she take, and C) Is it likely that a different triptan would be successful for treatment or do you have try a drug from a different pharmacologic class?
A) Valproic acid is most likely causing the patient’s weight gain
B) Patients can repeat naratriptan doses every 4 hours with a maximum dose of 5 mg/day.
C) It is possible that switching to a different triptan, such as sumatriptan, could provide the patient more symptomatic relief. You do not necessarily have to switch medication classes to see improvement.
Your patient asks about the use of the Butterbur for prevention of migraine headaches. You check:
A) Facebook
B) Google
C) Natural Medicines Database in Clinical Pharmacology
D) Instagram
C
What is the recommendation you found in the Natural Medicines Database?
The Natural Medicines Database states that Butterbur could “possibly be effective”, and is “possibly safe.” The data states that taking butterbur PO seems to prevent migraines and certain types can reduce the frequency, intensity, and duration of migraines when used by adults over a period of 16 weeks. They reported a dose of at least 75 mg is necessary to see these benefits.
The study analyzed the safety of options without any hepatotoxic pyrrolizidine alkaloid constituents and found that were safe when used for up to 16 weeks, but was not studied beyond that duration, and other options were also not studied.
Which NSAID has the fastest time to the peak effect for analgesia?
- Ibuprofen suspension
- Ibuprofen chewable
- Ibuprofen tablets or capsules
