Correct Answers to MODULE 1: The Diagnosis of Migraine in Primary Care
Pre-Post Test Questions (Correct Answer is Bold)
1. What is the prevalence of migraine in those that present to their primary care physicians with a complaint of headache?
Explanation: the correct answer is e. One study found that the prevalence of migraine was 76% in those that presented to their primary care physician with a complaint of headache. Another 14% met criteria for probable migraine, which are headaches that meet all but one of the diagnostic criteria for migraine.
2. The current diagnostic criteria for migraine without aura require 2 of 4 headache characteristics, 1 of 2 groupings of associated symptoms and a specific headache duration. Which of these headache descriptions would meet the criteria for migraine without aura?
a. Headache characteristics (unilateral headache, pulsating quality, severe pain intensity, not worse with exertion), associated symptoms (no nausea, but has photophobia and osmophobia) and duration of 4 hours
b. Headache characteristics (bilateral headache, pulsating quality, moderate pain intensity, worse with exertion), associated symptoms (no nausea, but has photophobia and osmophobia) and duration of 6 hours
c. Headache characteristics (bilateral headache, pulsating quality, moderate to severe pain intensity, worse with exertion), associated symptoms (nausea, but no photophobia and phonophobia) and duration of 12 hours
d. Headache characteristics (unilateral headache, sharp, mild pain intensity, not worse with exertion), associated symptoms (nausea, photophobia and phonophobia) and duration of 24 hours
Explanation: The correct answer is c. A migraine requires 2/4 clinical characteristics (unilateral, moderate to severe intensity, throbbing or pulsating, worse with exertion), 1/2 groupings of associated symptoms (either nausea/vomiting or both photophobia and phonophobia) and a duration of 4-72 hours.
3. ID migraine represents a three-item questionnaire that can be used to screen patients for migraine in your primary care practices. Data from the original study found that if two out of three questions were answered affirmatively then the probability of a diagnosis of migraine was ≥ 80%. What are the three symptoms used for this abbreviated diagnostic tool?
a. Nausea, photophobia and phonophobia with headaches
b. Nausea, throbbing and disability with headaches
c. Photophobia, phonophobia and disability with headaches
d. Unilateral location, nausea and phonophobia with headaches
e. Nausea, photophobia and disability with headaches
Explanation: The correct answer is e. ID migraine is comprised of three symptoms- nausea, photophobia and disability.
4. It is not uncommon for a patient to experience more than one headache disorder. This may make it more difficult to establish a diagnosis of migraine. How can you overcome this problem?
a. Ask the patient to describe their most severe or disabling headache type. They will typically describe migraines.
b. Ask the patient if they experience photophobia or phonophobia with their headaches. If they have either of these symptoms then they have migraine.
c. If they have unilateral headache then they have migraine regardless of the other headache characteristics.
d. If their headaches are throbbing then they have migraine.
Explanation: The correct answer is a. Migraine is generally identified by the most severe headache type by those with more than one headache type. One cannot rule in or rule out the diagnosis of migraine with the presence of one migraine symptom such as photophobia, phonophobia, unilateral location or throbbing quality.