Headache Quiz Bee

Chronic migraine, defined as headache occurring on at least ______ for more than _____ months

Chronic migraine, defined as headache occurring on at least fifteen days per month for more than three months

Chronic Migraine epidemiology

 1–2 percent of the population

Among adult patients with migraine, we recommend migraine prophylactic pharmacologic treatment in the following conditions: ______ headache days/month

4 or more headache days/month

Among adult patients with migraine, we recommend migraine prophylactic pharmacologic treatment in the following conditions: Migraine affects the ______ of the patient 

Migraine affects the personal, social, and professional life of the patient 

Among adult patients with migraine, we recommend migraine prophylactic pharmacologic treatment in the following conditions: ____ migraine relief despite ____ acute therapy 

Ineffective migraine relief despite adequate acute therapy 

Among adult patients with migraine, we recommend migraine prophylactic pharmacologic treatment in the following conditions: Frequent use of _____ for migraine attacks or increased risk of _____

Frequent use of acute medications for migraine attacks or increased risk of Medication Overuse Headache (MOH)

Among adult patients with migraine, we recommend migraine prophylactic pharmacologic treatment in the following conditions: _____ to use preventive treatment 

Patient preference to use preventive treatment 

Nutraceuticals for migraine headache (Low, Conditional)

We may recommend riboflavin (Vitamin B2), coenzyme Q10, and magnesium as complementary therapy for eligible patients. 

For acute treatment of migraine (Moderate, Conditional)

sumatriptan and naproxen

For acute treatment of migraine (High, Conditional)

paracetamol and caffeine

High, Strong for acute treatment of migraine

NSAIDs such as ibuprofen, diclofenac, aspirin, and naproxen as acute treatment for attacks of any severity. 

(DALY) and years lived with disability (YLD): migraine ranks _____ among young adults and _____ among young females 

Migraine ranks fourth among young adults and third among young females 

ID Migraine tool questions

Activity limitation, Nausea, Light sensitivity (getting a yes for 2 questions = 93% chance you have a migraine; 3 questions = 98% chance

First line drug for Cluster Headache

Verapamil

First line abortive therapy for cluster headache

Oxygen is often the first-line abortive therapy for acute cluster headache.

Adjunct for Cluster Headache

High-dose melatonin (up to 15 mg) can be used during cluster periods

Frequency and Duration criteria for SUNA and SUNCT 

15 days of headache each month for 3 months

Cerebral venous sinus thrombosis anticoagulation duration

3–6 months in provoked CVST, 6–12 months in unprovoked CVST, lifelong in recurrent CSVT or if severe thrombophilia (target international normalized ratio of 2–3) 

CADASIL implicated gene

NOTCH3 gene, on chromosome 19q13.1

CADASIL diagnostics apart from gene testing

Skin biopsy can be used when genetic testing is inconclusive or not available.

Skin biopsy findings in CADASIL

It involves examining small blood vessels in the skin for the presence of granular osmiophilic material (GOM), a distinctive feature of CADASIL.

New medication for the acute treatment of migraine targeting the TRPM8 receptor

Elismetrep - 20mg dose had best response for triptan resistant patients

Function of TRPM8 receptor

a protein linked to cold sensation and migraine susceptibility

A humanized monoclonal antibody used for the preventive treatment of migraines in adults and children 6 and older weighing at least 45 kg.

Fremanezumab - SPACE trial, Effective in episodic but not chronic migraine 

FDA-approved prescription medication for the acute treatment of migraine attacks (with or without aura).  It combines a fast-acting triptan with a long-lasting NSAID

Symbravo (meloxicam/rizatriptan) - It combines a fast-acting triptan with a long-lasting NSAID, enhanced by MoSEIC (Molecular Solubility Enhanced Inclusion Complex) technology to allow both drugs to peak in the blood in under an hour.

Investigational preventive migraine therapy by Lundbeck that target CGRP proteins

Bocunibart (LU-AG09222)

MOA of Bocunibart

Inhibits PACAP (pituitary adenylate cyclase-activating polypeptide), an entirely different pathway responsible for stress, pain-sensing nerve firing, and blood vessel widening  

Desired side effect of Atogepant

Weightloss

What is the conservative treatment for low CSF pressure headaches?

Bed rest, hydration, and caffeine

Rate of secretion of CSF

25mL/hr

The most common location for spontaneous CSF leak

Thoracic

Triptans with fast onset of action

sumatriptan, zolmitriptan, rizatriptan, almotriptan, and eletriptan

CGRP blocking antibody that is also FDA approved for episodic cluster headache 

Galcanezumab

Migraine prevention treatment: level B moderate evidence

amitriptyline,venlafaxine, atenolol, nadolol, feverfew, riboflavin

Migraine prevention treatment: level C weak evidence

clonidine, guanfacine, coenzyme Q10, and cyproheptadine

Migraine prevention treatment: level U insufficient evidence

verapamil, nicardipine, nifedipine, nimodipine, gabapentin, fluoxetine, fluvoxamine, protriptyline, bisoprolol, and acetazolamide

Treatment for Hypnic headache

CLIMA: caffeine, lithium, indomethacin, melatonin, and amitriptyline

Cluster Headache Pathophysiology Parasympathetic fibers from _______ of cranial nerve VII -> _______ of cranial nerve VII -> ________ ganglion -> Travel with _______ of CN V -> Lacrimal glands

Parasympathetic fibers from superior salivatory nucleus of cranial nerve VII -> Greater superficial petrosal nerve of cranial nerve VII -> Sphenopalatine ganglion -> Travel with maxillary divison of CN V -> Lacrimal glands

Which disease is usually associated with giant cell arteritis?

Polymyalgia rheumatica

The primary mechanism of action of onabotulinumtoxinA is by cleavage

of the ______, which is a component of _______ protein

The primary mechanism of action of onabotulinumtoxinA is by cleavage

of the SNAP25 protein, which is a component of SNARE (Soluble Nethylmaleimide-

sensitive factor Attachment protein Receptor) protein

What is the global migraine prevalence?

15% (1 in 7)

Affected Women and Men

• Women: ~18–20%

• Men: ~6–8%

• Female:male ratio: ~3:1

Peak age of onset in migraine

Peak prevalence: 25–55 years

Global Burden of Disease (GBD) specify that Migraine affects approximately _____ people worldwide.

Migraine affects approximately 1.1–1.2 billion people worldwide.

Nummular Headaches are felt exclusively on the area of the scalp measuring ______ in diameter.

1-6 cm

What does CGRP stand for?

Calcitonin Gene-Related Peptide

What does PACAP stand for?

Pituitary Adenylate Cyclase Activating Peptide

Phase 3 trial for Atogepant 60mg for the Acute treatment of Migraine

ECLIPSE trial (AbbVie)

Primary endpoint of ECLIPSE trial

Pain freedom at 2 hours after treatment of the first migraine attack

What dose of oral indomethacin is required for the diagnosis of hemicrania continua (HC)?

≥150 mg daily increasing up to 225 mg