Headache 1
Headache 2
Headache 3
Headache 4
Case and S/s of the headaches
100
To be classified as a migraine headache, a patient must experience 5 or more Headaches lasting 4-72 hours with at least ONE of the following:
What is 1)One-side, pulsating pain 2)Aggravated by or causing avoidance of routine physical activity And at least one of these? Nausea/vomiting Photophobia Phonophobia
100
A headache which occurs with bilateral non-throbbing pain often associated with head, neck, or shoulder muscle tenderness.
What is a tension type headache.
100
Cluster headaches manifest as sudden, short, and severe always unilateral pain in the supraorbital or temporal lobes that is often associated with ipsilateral autonomic symptoms. Name 2 of these symptoms.
What are: Ptosis, Miosis, Lacrimation, Conjunctival injection, Rhinorrhea, and Nasal congestion -------------Daily double option---------
100
When referring to Medication Over-Use Headaches, which of the following is NOT true: -More commen in Women vs Men -The Highest risk medications for MOH are: opioids, butalbital containing analgesics, asa/apap/caffeine combinations -Intermediate risk meds: triptans -Lowest risk meds: NSAIDs -It manifests more frequently at bedtime
What is It Manifests More Frequently at Bedtime. Rationale: It commonly manifests UPON AWAKENING and lasts almost all day
100
Pt presents to Clinic complaining of a headache mainly on the left side of his head with a pulsating quality. He states that shortly before the headache started he experienced partial loss of vision in one eye. What type of headache is he experiencing?
What is a Migraine with Aura
200
“Typical _____ symptoms include visual symptoms such as flickering lights, spots or lines and/or partial loss of vision; sensory symptoms such as numbness and/or pins and needles; and/or speech disturbance.”
What is an Aura
200
When a TTH occurs 15 or more times in a month for more than 3 months it is considered a __________ TTH
What is a chronic TTH
200
This Gender experiences more cluster headaches than the other gender
What are males
200
For a MOH Diagnosis, how many days in a month does a headache have to be present, and what is the relation with drug use?
What is a Headache for at least 15 days per month in presence of drug use for at least 10 days a month. (3 months of symptoms for diagnosis)
200
There are multiple Contraindications for Triptans, Name 1.
What are: ischemic heart disease, uncontrolled HTN, concurrent ergot derivative or MAOI use, Cerebrovascular and peripheral vascular disease. -------------Daily DOUBLE OPTION----------------
300
What is wrong with this statement: 1st line therapy for Migraines includes the use of triptans in mild to moderate cases and NSAIDs in moderate to severe cases, or for those that fail triptan therapy.
What is: switch the term "triptans" with "NSAIDs" Rationale: NSAIDs are 1st line for mild-moderate Triptans are 1st line for mod-severe or in those that failed NSAID therapy Ergotamines: DHE (not with triptans or CYP3A4 inhibitors or with MAOIs), Antiemetics:metoclopramide or prochlorperazine, opioids/barbs last resort
300
Tension Type Headaches are not caused by a neurotransmitter or vascular dysfunction. Which drug class is used to treat Episodic TTHs?
What are NSAIDs
300
Which of the following is not a recommended acute treatment for a Cluster Headache: Oxygen, Sumatriptan, Analgesics, DHE (Dihydroergotamine), Steroids.
What are Analgesics
300
There are 2 common forms of treatment in treating MOH, they include the Cold Turkey technique and the slow weaning technique. What MOH inducing agents DISALLOW an individual from using the COLD TURKEY technique?
What are opioid affiliated MOHs.
300
OJ is at his pharmacy picking up a prescription for Verapamil and Lithium. The Student pharmacist was surprised when OJ said the medications were for his headaches. OJ said he often experiences a terrible headache on one side of his head that lasts for about an hour and occurs multiple times in the day. What type of Headache Does OJ likely have?
What is a cluster headache
400
There are 3 routinely recommended drug classes for Migraine preventation, name 1 class.
What are: Beta blockers (propranolol, timolol, metoprolol), Anticonvulsants (valproate, topiramate), and/or antidepressants (amitriptyline, venlafaxine)
400
Opioids are a recommended first line treatment for this type of headache.
What is opioids are not a first line treatment for any headache type?
400
Verapamil is a first line treatment for Cluster Headache prophylaxis (along with Lithium and topiramate). It is usually dosed at up to 480/mg per day as tolerated. What is a Brand name formulation of Verapamil and one counseling point?
What are: Calan, Calan SR, Isoptin SR Hypotension, bradyarrhythmia, peripheral edema, syncope, or Rebound Hypertension
400
Treatment of MOH should include many components. Name 2 of these
What is: 1. withdrawl of overused medication ASAP, 2. bridge therapy to transition with NSAID or prednisone, 3. ppx to help with withdrawl s/s, 4. clonidine for opioid withdrawl, 5. Possible inpatient treatment or additional resource help for addictions
400
MJ has been experiencing recurrent headaches over the last 4 months. They occur as often as 15-20 days a month, and have gotten so severe that doubling her regular Fiorcet dose during the outbreaks is no longer cutting it. She reports severe neck pain, nonrestorative sleep, and pressure around her sinuses and frontal lobe. What type of headache is MJ experiencing?
What is a Medication overuse headache
500
A Pt with ____ number of debilitating attacks per month and/or requiring drug therapy >____ days a week, indicates someone who requires prophylactic treatment.
What is: Greater than or equal to 2 and >2 days a week
500
Options for Chronic TTH prophylactic treatment include _______.
What are TCAs, SSRIs, Myofascial Trigger Point Therapy, Acupuncture, TENS
500
How does the time of headache free period duration change as age increases in Cluster Headache?
What is: UP! There is light at the end of the tunnel
500
To prevent a MOH from occurring, what is the maximum days in a month that triptans or over the counter combination analgesics should be used?
What is 9 days per month. - NSAIDs are 15 days/month, Butalbital-containing products is 3 days and Opioids should be avoided for regular use.
500
AJ experiences about 5 headaches a month and describes them as a tight pain emanating from her neck. What type of headache does AJ likely have.
What is an Episodic Tension Type Headache.
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