BCPP Exam Reviews Questions/Answer 2025/2026
Graded A+
Migraine without aura (classical migraine) diagnostic criteria - ≥5 headaches lasting 4-
72 hours, unilateral, pulsating, moderate-severe pain, aggravation w/ physical activity,
w/ nausea/vomiting, photophobia, phonophobia
Migraine with aura (common migraine) - ≥2 headaches with aura sx (visual, sensory,
verbal, or motor disturbances) developing gradually over 4 minutes for up to 60 minutes
prior to migraine
Status migrainosus diagnostic criteria - ≥72 hours, requiring hospital management for
pain and dehydration d/t vomiting
Basilar-type migraine diagnostic criteria - bilateral pain at back of the head
Hemiplegic migraine diagnostic criteria - temporary paralysis on one side of body
Headache Impact Test (HIT-6) - Use: migraines
Self-rated
Assess impact on lives
50-55 some impact
56-59 substantial impact
≥60 severe impact
Migraine Disability Assessment Questionnaire (MIDAS) - Use: migraines
Self-rated
Measure headache-related disability
0-5 little or no disability
6-10 mild disability
11-20 moderate disability
≥21 severe disability
Migraine-Specific Quality of Life Survey (MSQ 2.1) - Use: migraines
Self-rated
Measure how migraines limit daily social and work related activities
Higher score = better QOL
Pain Disability Index (PDI) - Use: migraines
Self-rated
Measures degree headaches disrupt daily living Higher score = greater disability
Migraine Treatment Guidelines - Abortive:
-Mild to moderate: NSAIDs, acetaminophen, aspirin + caffeine
-Moderate to severe: triptans, ergots
,Prophylaxis:
-Indications for use: ≥2 attacks/month, disability ≥3 days/month, frequent or severe HAs,
use of abortive meds ≥2x/week
-First-line: VPA, beta-blockers, Topamax, Butterbur (level A evidence)
-Second-line: TCAs, magnesium, feverfew, venlafaxine
Migraine treatments in pregnancy - Category A: magnesium, transcutaneous electrical
nerve stimulation device
Category B: cyproheptadine, metoclopramide
Category C/D: butorphanol nasal spray, oral steroids, opiate combos, beta-blockers,
Botox, CCBs, ARBs
Category ergots, VPA
Not safe: Butterbur, feverfew
Migraine treatment in the ER setting - VPA, magnesium, methylpred, repetitive IV
dihydroergotamine infusion (Raskin protocol)
Migraine treatment in pediatrics - sumatriptan effective for ≥6 yo, almotriptan and
Topamax approved for ≥12 yo
Huntington's Disease Symptoms: - motor, psychiatric, cognitive, autonomic (urinary
incontinence, impaired BP regulation)
The United Huntington's Disease Rating Scale (UHDRS) - Use: Huntington's Disease
Clinician-rated
Evaluate function, capacity, and behaviors Higher score = greater motor impairment
Huntington's Disease Clinical Course - Early: subtle manifestations (involuntary
movements, some mood/cognitive issues)
Middle: chorea prominent, worsening dysphagia/dysarthria, severe cognitive effects and
impaired ADLs
Late: severe chorea - rigid and bradykinetic, global dementia, patients bedridden and
nonverbal
Huntington's Disease Treatment Guidelines - First-line: amantadine, CoQ10, ethyl-EPA,
minocycline, riluzole, tetrabenazine
Second-line: creatine, nabilone
Mood disorders: SSRIs, mood stabilizers > lithium
Neuropathic Pain Scale - Use: neuropathic pain
Self-rated
Measure aspects of pain
Higher scores = greater pain
Pain Quality Assessment Scale - Use: neuropathic pain
Self-rated
, Assess pain quality
Higher scores = greater pain
Neuropathic Pain Treatment Guidelines - First-line: duloxetine, gabapentin/pregabalin,
TCAs (amitriptyline preferred in NICE); (oxycodone, Effexor)
Second-line: CBZ, LTG, tramadol, VPA, combos; (opioids, Effexor)
Third/fourth-line: capsaicin, lidocaine, topiramate, TENS
Neuropathic Pain in Pregnancy - Pregnancy: capsaicin and lidocaine cream category B,
capsaicin patch category A, excreted in breast milk
Landmark trial: corticosteroids in acute herpes zoster - Results showed that
corticosteroids do not prevent postherpetic neuralgia in patients with acute herpes
zoster
TBI Severity Classification - Mild: GCS 13-15, <30 min LOC, <1 hr posttraumatic
amnesia
Moderate: GCS 9-12, 30 min-24 hrs LOC, 1-24 hr posttraumatic amnesia
Severe: GCS ≤8, >24 hour LOC, >24 hr posttraumatic amnesia
TBI chronic complications - seizures, behavioral and affective, sensory sensitivity,
movement disorders, HA, dementia
Glasgow Coma Scale (GCS) - Use: TBI
Clinician-rated
Assess coma and impaired consciousness
13-15 mild brain injury
9-12 moderate brain injury
3-8 severe brain injury
Disability Rating Scale - Use: TBI
Clinician- and self-rated
Measure functional changes over course of recovery Likert scale from 0 (no disability) to
29 (extreme vegetative state)
Acute TBI Treatment - Maintain ICP <20 mmHg w/ IV mannitol or hypertonic saline
Chronic TBI Treatment - Pharmacologic issues: increased sensitivity to CNS effects,
cognitive impairment from anticholinergics, paradoxical agitation from BZDs, motor
effects from dopamine antagonists and Li
-Depression: SSRIs; avoid TCAs and bupropion
-Mania, irritability, poor frustration tolerance: anticonvulsants (VPA and CBZ preferred);
Li effective, but increases risk of neurotoxic effects and DI
-Cognitive deficits: dopamine agonists, stimulants, donepezil
-Agitation: beta-blockers (propranolol, pindolol)
Graded A+
Migraine without aura (classical migraine) diagnostic criteria - ≥5 headaches lasting 4-
72 hours, unilateral, pulsating, moderate-severe pain, aggravation w/ physical activity,
w/ nausea/vomiting, photophobia, phonophobia
Migraine with aura (common migraine) - ≥2 headaches with aura sx (visual, sensory,
verbal, or motor disturbances) developing gradually over 4 minutes for up to 60 minutes
prior to migraine
Status migrainosus diagnostic criteria - ≥72 hours, requiring hospital management for
pain and dehydration d/t vomiting
Basilar-type migraine diagnostic criteria - bilateral pain at back of the head
Hemiplegic migraine diagnostic criteria - temporary paralysis on one side of body
Headache Impact Test (HIT-6) - Use: migraines
Self-rated
Assess impact on lives
50-55 some impact
56-59 substantial impact
≥60 severe impact
Migraine Disability Assessment Questionnaire (MIDAS) - Use: migraines
Self-rated
Measure headache-related disability
0-5 little or no disability
6-10 mild disability
11-20 moderate disability
≥21 severe disability
Migraine-Specific Quality of Life Survey (MSQ 2.1) - Use: migraines
Self-rated
Measure how migraines limit daily social and work related activities
Higher score = better QOL
Pain Disability Index (PDI) - Use: migraines
Self-rated
Measures degree headaches disrupt daily living Higher score = greater disability
Migraine Treatment Guidelines - Abortive:
-Mild to moderate: NSAIDs, acetaminophen, aspirin + caffeine
-Moderate to severe: triptans, ergots
,Prophylaxis:
-Indications for use: ≥2 attacks/month, disability ≥3 days/month, frequent or severe HAs,
use of abortive meds ≥2x/week
-First-line: VPA, beta-blockers, Topamax, Butterbur (level A evidence)
-Second-line: TCAs, magnesium, feverfew, venlafaxine
Migraine treatments in pregnancy - Category A: magnesium, transcutaneous electrical
nerve stimulation device
Category B: cyproheptadine, metoclopramide
Category C/D: butorphanol nasal spray, oral steroids, opiate combos, beta-blockers,
Botox, CCBs, ARBs
Category ergots, VPA
Not safe: Butterbur, feverfew
Migraine treatment in the ER setting - VPA, magnesium, methylpred, repetitive IV
dihydroergotamine infusion (Raskin protocol)
Migraine treatment in pediatrics - sumatriptan effective for ≥6 yo, almotriptan and
Topamax approved for ≥12 yo
Huntington's Disease Symptoms: - motor, psychiatric, cognitive, autonomic (urinary
incontinence, impaired BP regulation)
The United Huntington's Disease Rating Scale (UHDRS) - Use: Huntington's Disease
Clinician-rated
Evaluate function, capacity, and behaviors Higher score = greater motor impairment
Huntington's Disease Clinical Course - Early: subtle manifestations (involuntary
movements, some mood/cognitive issues)
Middle: chorea prominent, worsening dysphagia/dysarthria, severe cognitive effects and
impaired ADLs
Late: severe chorea - rigid and bradykinetic, global dementia, patients bedridden and
nonverbal
Huntington's Disease Treatment Guidelines - First-line: amantadine, CoQ10, ethyl-EPA,
minocycline, riluzole, tetrabenazine
Second-line: creatine, nabilone
Mood disorders: SSRIs, mood stabilizers > lithium
Neuropathic Pain Scale - Use: neuropathic pain
Self-rated
Measure aspects of pain
Higher scores = greater pain
Pain Quality Assessment Scale - Use: neuropathic pain
Self-rated
, Assess pain quality
Higher scores = greater pain
Neuropathic Pain Treatment Guidelines - First-line: duloxetine, gabapentin/pregabalin,
TCAs (amitriptyline preferred in NICE); (oxycodone, Effexor)
Second-line: CBZ, LTG, tramadol, VPA, combos; (opioids, Effexor)
Third/fourth-line: capsaicin, lidocaine, topiramate, TENS
Neuropathic Pain in Pregnancy - Pregnancy: capsaicin and lidocaine cream category B,
capsaicin patch category A, excreted in breast milk
Landmark trial: corticosteroids in acute herpes zoster - Results showed that
corticosteroids do not prevent postherpetic neuralgia in patients with acute herpes
zoster
TBI Severity Classification - Mild: GCS 13-15, <30 min LOC, <1 hr posttraumatic
amnesia
Moderate: GCS 9-12, 30 min-24 hrs LOC, 1-24 hr posttraumatic amnesia
Severe: GCS ≤8, >24 hour LOC, >24 hr posttraumatic amnesia
TBI chronic complications - seizures, behavioral and affective, sensory sensitivity,
movement disorders, HA, dementia
Glasgow Coma Scale (GCS) - Use: TBI
Clinician-rated
Assess coma and impaired consciousness
13-15 mild brain injury
9-12 moderate brain injury
3-8 severe brain injury
Disability Rating Scale - Use: TBI
Clinician- and self-rated
Measure functional changes over course of recovery Likert scale from 0 (no disability) to
29 (extreme vegetative state)
Acute TBI Treatment - Maintain ICP <20 mmHg w/ IV mannitol or hypertonic saline
Chronic TBI Treatment - Pharmacologic issues: increased sensitivity to CNS effects,
cognitive impairment from anticholinergics, paradoxical agitation from BZDs, motor
effects from dopamine antagonists and Li
-Depression: SSRIs; avoid TCAs and bupropion
-Mania, irritability, poor frustration tolerance: anticonvulsants (VPA and CBZ preferred);
Li effective, but increases risk of neurotoxic effects and DI
-Cognitive deficits: dopamine agonists, stimulants, donepezil
-Agitation: beta-blockers (propranolol, pindolol)
