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Nurse Practitioner:
doi: 10.1097/01.NPR.0000422618.89047.0a
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When tension headaches become chronic

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INSTRUCTIONS When tension headaches become chronic

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When tension headaches become chronic

General Purpose: To provide an overview of the causes and treatment of TTH, CTTH, and MOH. Learning Objectives: After reading this article and taking this test, the learner should be able to: 1. Describe the classification and pathophysiology of TTH and CTTH. 2. Explain how to diagnose TTH, CTTH, and MOH. 3. Illustrate the preventive measures and treatment options for TTH, CTTH, and MOH.

1. Which statement describing TTH is accurate?

a. It is the most common form of headache.

b. It is the most effectively treated type of headache.

c. It is more prevalent in males.

d. It reaches peak levels in adults between 40 and 50 years old.

2. CTTH is defined as having a TTH

a. a minimum of once per day.

b. less than 12 times per month.

c. 15 or more days per month.

d. at least 90 days per year.

3. One symptom used in identifying TTH is

a. a throbbing, pulsating pain.

b. pain on both sides of forehead, temples, or back of the head.

c. a severe degree of pain.

d. pain worsened by physical activity.

4. THH can be associated with

a. decreased pericranial myofascial pain sensitivity.

b. an aura such as a visual change indicating onset.

c. nausea and vomiting.

d. photophobia or phonophobia.

5. TTH triggers include stress, smoking, alcohol use, and

a. poor posture.

b. overeating.

c. lack of exercise.

d. cold exposure.

6. Diagnosis of TTH requires a detailed patient history, a normal physical exam, and a(an)

a. neurologic exam.

b. CT scan of the brain.

c. MRI of the brain.

d. electroencephalogram.

7. Which situation would not necessarily warrant a brain imaging study?

a. new headaches in an older patient

b. headaches that are worse with Valsalva

c. a family history of headaches

d. headaches induced by exertion

8. The patient complaining of the “worst headache ever” should be

a. referred to the ED for a neurology consult and have imaging of the brain.

b. diagnosed with onset of TTH.

c. treated with a strong analgesic and keep a 4-week headache diary.

d. referred to a pain management specialist for interventional therapy.

9. Headache red flags include all of the following except

a. fever and weight loss.

b. neurologic symptoms.

c. sudden, abrupt onset.

d. photophobia or phonophobia.

10. Women who have migraine headaches with aura should avoid

a. opioids.

b. ergotamines.

c. oral contraceptives.

d. nonsteroidal anti-inflammatory drugs (NSAIDs).

11. The patient in the case scenario converted from episodic TTH into CTTH because of

a. under treatment.

b. increased stress over time.

c. development of hypertension.

d. medication overuse.

12. Which of the following is one of the criteria for a diagnosis of MOH?

a. headaches present up to 10 days per month

b. over 3 months of regular analgesic overuse for acute treatment

c. headaches improve only slightly during medication overuse

d. headaches markedly worsen after discontinuation of medication

13. The EFNS headache panel guidelines recommended treatment of MOH by

a. abruptly withdrawing analgesics.

b. tapering withdrawal of NSAIDs.

c. alternating ergotamine and triptan treatment.

d. keeping a headache diary.

14. Which drugs should be tapered off in patients with MOH?

a. analgesics

b. benzodiazepines

c. triptans

d. ergotamine derivatives

15. The patient with MOH who discontinues medication after overuse can expect

a. immediate improvement of the acute headache.

b. improvement of the acute headache over days or weeks.

c. eventual return of headache to previous levels.

d. muscle soreness and bradycardia during the first week.

16. Prevention of CTTH may be accomplished through use of

a. tricyclic antidepressants.

b. serotonin 5-HT receptor agonists.

c. ergotamines.

d. triptans.

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