Chapter 54. Headache
Which of the following are prophylactic treatment options for migraine headache? Select all that apply.
Answer a is correct. Verapamil is a calcium-channel blocker that is used for migraine prophylaxis. It would be useful for patients who cannot tolerate β-blockers or for patients with comorbid hypertension or angina.
Answer b is correct. Topiramate is an antiepileptic medication that was approved for use in migraines in 2004. It is dosed twice daily for migraine prevention. It would be useful for a patient with comorbid seizure disorder. It does have some more prominent cognitive side effects with >10% incidence, including memory difficulties, difficulty in concentrating, confusion, and speech difficulties.
Answer c is correct. Valproic acid is an antiepileptic medication also approved for migraine prophylaxis. It would be useful for those patients with comorbid seizure disorder or manic depressive illness.
Answer d is incorrect. Ergotamine is a medication that is only used for acute migraine treatment and should not be used for prophylaxis.
JJ is a 49-year-old man who experiences headache cycles two times a year, usually in the spring and fall. The headaches occur for about 3 to 4 weeks and he may have up to 5 headaches daily. The headaches are an unbearable type of pain that comes suddenly, located in his left eye, and stops within 1 to 2 hours. He experiences severe ocular and nasal symptoms, such as nasal stuffiness or rhinorrhea, ocular lacrimation, and ptosis. He tells you that in order to attempt to stop the pain, he sometimes rubs the areas of pain or even beats his head against objects. Which of the following are appropriate abortive treatment options for this patient's headache?
b. Fremanezumab-vfrm (Ajovy)
Answer a is correct. Oxygen administered at 5 to 10 L/min by nonrebreather facemask for approximately 15 minutes is a first-line abortive treatment for cluster headache. This patient exhibits primary symptoms of cluster headache as per the International Headache Society Diagnostic Criteria for Migraine:
Headache is unilateral, orbital in location, lasting for 15 to 180 minutes.
Nasal congestion, rhinorrhea, ocular lacrimation, and ptosis are present.
Frequency of headaches lasts from 7 days to 1 year.
Answer b is incorrect. Calcitonin gene-related peptide (CGRP) antagonists are used in the management of migraine.
Answers c and d are incorrect. Amitriptyline and topiramate are prophylactic ...