NURS 6030 Adv Prim Care Exam 2 Questions With
Complete Solutions
what is a primary headache? give examples
not symptomatic of underlying cause
ex: migraine, tension, cluster
what is a secondary headache?
caused by underlying condition
explain the 4 phases of migraine
prodrome: triggers
aura: visual/auditory
headache
postdrome: may be euphoric/fatigued
describe characteristics of POUND as it concerns migraines
pulsatile, one day duration, unilateral, nausea or vomiting,
disabling intensity
explain criteria for migraine WITHOUT aura
A: at least 5 attacks
B: headache lasting 4-72hrs
C: Headache has at least 2 of the following:
unilateral location, pulsating quality, moderate or severe pain
intensity, aggravation by or causing avoidance of physical
,activity
D: During headache at least 1 of the following: n/v ,
photophobia/phonophobia
explain criteria for migraine WITH aura
A: at least 2 attacks
B: 1 or more of the following fully reversible aura symptoms-
visual, sensory, speech/language, motor, brainstem, retinal
C: at least 2 of the following: 1 aura symptom spreads greater
than 5 min or 2 auras occur in succession
-each individual aura symptom lasts 5-60 min
-at least 1 aura symptom unilateral
-aura accompanied or followed within 60 min of headache
what should physical exam include concerning migraine?
BP, T, HR, fundoscopic exam to look for papilladema (indicates
increase cranial pressure), palpate head, neck, and sinuses,
palpate TM, mental status
when may workup for headache be necessary?
if secondary cause suspected
what labs may be done for headache?
CBC, ESR, thyroid function, CT only in emergencies
what is the pharmacologic treatment for mild to moderate
headaches/migraines? what educated should be provided?
,-NSAIDs, acetaminophen, aspirin, emetic if vomiting
-warn about rebound headache from prolonged use
what is the pharmacologic treatment for moderate to severe
migraine?
triptans, can be combined with NSAIDs (triptan + naproxen)
what should you council to patients regarding medication for
severe migraines?
take at first sign of migraine
what are contraindications of triptans?
should not be given to patients with vascular disease,
contraindicated with ergotamines and MAO inhibitors
what is the consideration for triptans use in pregnancy?
should try tylenol + caffeine first, if that doesn't work can then
try sumatriptan as considered low risk; may refer to specialist
what are in-office options for migraine management?
sumatriptan subq, keterolac IM, diphenhydramine IM (helps to
settle down/sleep), dexamethasone IM (helps with rebound H/A
in postdromal phase
what is the nonpharmacologic management for
headache/migraine?
relaxation, biofeedback, acupuncture, cognitive behavioral
therapy
, when should a patient with migraine transition from abortive
pharm management to preventative?
if they have more than 2 headaches a week, if they need more
than 9-10 triptans in a month
what are examples of preventative therapy medications that may
be used for migraines?
beta blockers- propanolol, antidepressants (SSRI/tricyclic like
amitriptyline), anticonvulsants (topiramate, valproate),
calcitonin gene related peptide (aimovig, gality)- requires failure
of all other tx before use
what are alternatives for prevention of migraines/headaches?
magnesium, coenzyme Q10, feverfew, butterbur
what are common culprits of medication overuse headaches?
how to prevent overuse?
-opioids, butalbital combos, caffeine combos, NSAIDs
-do not take meds more than 10 days/month, prophylactic med
for primary headache disorder
what are precipitating factors of tension headache?
stress and mental tension
what is the criteria for tension type headache?
-at least 2 of following: bilateral location, pressing or tightening
(non-pulsating), mild to moderate intensity, not aggravated by
Complete Solutions
what is a primary headache? give examples
not symptomatic of underlying cause
ex: migraine, tension, cluster
what is a secondary headache?
caused by underlying condition
explain the 4 phases of migraine
prodrome: triggers
aura: visual/auditory
headache
postdrome: may be euphoric/fatigued
describe characteristics of POUND as it concerns migraines
pulsatile, one day duration, unilateral, nausea or vomiting,
disabling intensity
explain criteria for migraine WITHOUT aura
A: at least 5 attacks
B: headache lasting 4-72hrs
C: Headache has at least 2 of the following:
unilateral location, pulsating quality, moderate or severe pain
intensity, aggravation by or causing avoidance of physical
,activity
D: During headache at least 1 of the following: n/v ,
photophobia/phonophobia
explain criteria for migraine WITH aura
A: at least 2 attacks
B: 1 or more of the following fully reversible aura symptoms-
visual, sensory, speech/language, motor, brainstem, retinal
C: at least 2 of the following: 1 aura symptom spreads greater
than 5 min or 2 auras occur in succession
-each individual aura symptom lasts 5-60 min
-at least 1 aura symptom unilateral
-aura accompanied or followed within 60 min of headache
what should physical exam include concerning migraine?
BP, T, HR, fundoscopic exam to look for papilladema (indicates
increase cranial pressure), palpate head, neck, and sinuses,
palpate TM, mental status
when may workup for headache be necessary?
if secondary cause suspected
what labs may be done for headache?
CBC, ESR, thyroid function, CT only in emergencies
what is the pharmacologic treatment for mild to moderate
headaches/migraines? what educated should be provided?
,-NSAIDs, acetaminophen, aspirin, emetic if vomiting
-warn about rebound headache from prolonged use
what is the pharmacologic treatment for moderate to severe
migraine?
triptans, can be combined with NSAIDs (triptan + naproxen)
what should you council to patients regarding medication for
severe migraines?
take at first sign of migraine
what are contraindications of triptans?
should not be given to patients with vascular disease,
contraindicated with ergotamines and MAO inhibitors
what is the consideration for triptans use in pregnancy?
should try tylenol + caffeine first, if that doesn't work can then
try sumatriptan as considered low risk; may refer to specialist
what are in-office options for migraine management?
sumatriptan subq, keterolac IM, diphenhydramine IM (helps to
settle down/sleep), dexamethasone IM (helps with rebound H/A
in postdromal phase
what is the nonpharmacologic management for
headache/migraine?
relaxation, biofeedback, acupuncture, cognitive behavioral
therapy
, when should a patient with migraine transition from abortive
pharm management to preventative?
if they have more than 2 headaches a week, if they need more
than 9-10 triptans in a month
what are examples of preventative therapy medications that may
be used for migraines?
beta blockers- propanolol, antidepressants (SSRI/tricyclic like
amitriptyline), anticonvulsants (topiramate, valproate),
calcitonin gene related peptide (aimovig, gality)- requires failure
of all other tx before use
what are alternatives for prevention of migraines/headaches?
magnesium, coenzyme Q10, feverfew, butterbur
what are common culprits of medication overuse headaches?
how to prevent overuse?
-opioids, butalbital combos, caffeine combos, NSAIDs
-do not take meds more than 10 days/month, prophylactic med
for primary headache disorder
what are precipitating factors of tension headache?
stress and mental tension
what is the criteria for tension type headache?
-at least 2 of following: bilateral location, pressing or tightening
(non-pulsating), mild to moderate intensity, not aggravated by
