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A 29 year old woman with history of migraine without aura presents at 6 weeks gestation with throbbing, unilateral headaches lasting 4-72 hours with light sensitivity and nausea. Which of the following next steps is most appropriate?

1 point

MRI, MRA and MRV brain with gadolinium to look for aneurysm, mass, and cerebral venous sinus thrombosis

Urine protein and blood pressure check to identify preeclampsia

Urgent CT of the head

Obtain further history and exam, including details of the prior history of migraine headache and family history

Lumbar puncture

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Which of the following physiological changes is thought to be most related to sensitivities to light and sound in a migraine patient?

1 point

Injury to the blood vessels and meninges

Hypersensitivity (sensitization) of the central nervous system and sensory nerves

Central nervous system release of norepinephrine and serotonin from neurons

Hypersynchronous neuronal activity resulting in spike and slow wave activity

None of the above; the physiology of migraine is completely unknown

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Which of the following preventative medications should be avoided if possible as a migraine preventative drug in a pregnant patient?

1 point

Magnesium oxide

Amitriptyline

Metoprolol

Topiramate

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Which of the following statements regarding the acute treatment of migraines in pregnancy is accurate?

1 point

Sumatriptan can be used sparingly in pregnancy – but it can raise the blood pressure in the third trimester.

Acetaminophen is seldom used for pain in pregnancy because of its high risk to the developing fetus, in particular, closure of the patent ductus arteriosus.

Ibuprofen is a Category A medication and is commonly used throughout the entirety of pregnancy.

There are no appropriate drugs to use in pregnancy; women with migraines should get used to the pain and should be counseled that childbirth is much more painful.

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What is the affective component of pain?

1 point

The emotional component of pain

The organ systems the pain affects

The people in the community who support an individual with chronic pain

The blood pressure and heart rate changes that occur with pain

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Which of the following statements regarding non-medication therapies for migraines in pregnancy is accurate?

1 point

The age of the patient is the primary determinant of the success of non-medication strategies in general

Most pregnant patients are not interested in treatments for migraine other than medication

There is little evidence but no harm in herbal supplementation (feverfew, butterbur) for migraine treatments during pregnancy

Strategies like biofeedback and cognitive behavioral therapy, applied to migraine, are strongly evidence-based and can reduce migraines by 30-60%.

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