Pre-Test

Morgan: A 14-year old girl with worsening headaches

  1. Which of the following people are among those likely to be most helpful in diagnosing and managing headache in an adolescent? Select all that apply.
    1. The patient
    2. The school nurse
    3. A pharmacist
    4. The on-line community (Facebook, bloggers, self-help sites, etc.)
    5. An acupuncturist
    6. A psychologist
    7. Friends

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  2. When obtaining a history from an adolescent patient with suspected migraine headache, which of the following should be asked?
    1. What exacerbates the symptoms?
    2. Were there any anomalies when you were born?
    3. When did the symptoms start?
    4. What has been done so far?

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  3. Which of the following are possible signs and symptoms of migraine headache in adolescents? Select all that apply.
    1. Light sensitivity
    2. Pain
    3. Agitation/mania
    4. Nasal congestion
    5. Poor school performance

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  4. Which one of the following best describes common treatments for adolescent migraine?
    1. acupuncture
    2. biofeedback
    3. cognitive behavioral therapy
    4. medications
    5. behavioral self-care
    6. all of the above

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  5. Which of the following medications and vitamins are used to treat adolescent migraine? Select all that apply.
    1. Botox
    2. Topiramate
    3. Serotonin agonists
    4. Riboflavin
    5. Amoxicillin
    6. Albuterol

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    Answers: a, b, c, d only
  6. Which of the following risks should be addressed with adolescents experiencing migraine?
    1. Self-medication
    2. Triggers (food, sleep, etc.)
    3. Potential side-effects of treatments
    4. Cost of therapies
    5. Privacy risks of digital technologies for self-care
    6. All of the above.

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  7. How quickly should an adolescent with migraine expect to experience good control of migraine headache?
    1. Within hours of first visit and treatment
    2. Diagnosis may take more than one visit, but treatment immediately produces a cure.
    3. After diagnosis, adolescent should expect to try a variety of therapeutic options, including behavioral self-care, to find a regimen that works best for her.
    4. Good control is typically rare. Adolescents should adapt their lifestyles to accommodate monthly debilitating headaches including a modified school plan.

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  8. Which of the following preventive treatments for migraine is associated with weight loss?
    1. Propranolol
    2. Valproic acid
    3. Topiramate
    4. Amitripyline

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  9. Which one of the following drug classes is used in the acute treatment of migraine headaches in the pediatric population?
    1. Serotonin agonists
    2. Antihistamines
    3. Antidepressants
    4. Anticonvulsants

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  10. Which of the following vitamins has evidence to support efficacy in migraine prevention?
    1. Ascorbic acid
    2. Riboflavin
    3. Cyanocoblamin
    4. Pyridoxine

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  11. Which of the following medications used in migraine prophylaxis is most likely associated with major congenital malformations?
    1. Topiramate
    2. Cyproheptadine
    3. Propranolol
    4. Valproic acid

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Study Questions for the Adolescent Headache Case

  1. What are special considerations for treatment of an adolescent with this condition, compared to an adult?
  2. What lessons about self-medication does this case teach?
  3. What migraine triggers should be considered in creating a management plan?
  4. How can the patient collaborate in managing her headaches?
  5. How does the patient's anxiety affect her symptoms and relate to her treatment?
  6. Why is non-pharmcologic treatment recommended in addition to treatment with medications?