Which of the triptans listed is available in more than one medication delivery formulation?
A. Almotriptan (Axert)
C. Frovatriptan (Frova)
D. Naratriptan (Amerge)
E. Eletriptan (Relpax)
The answer is B. Multiple formulations are currently available for sumatriptan (Imitrex; subcutaneous injection, swallowed tablet, intranasal spray), zolmitriptan (Zomig; swallowed tablet, orally dissolving tablet, intranasal spray), and rizatriptan (Maxalt: orally dissolving tablet, swallowed tablet). Eletriptan (Relpax), almotriptan (Axert), naratriptan (Amerge), and frovatriptan (Frova) are available only in tablets that need to be swallowed. (Tfelt-Hansen, De Vries, & Saxena, Drugs 2000)
Which is the least common gene linked to familial hemiplegic migraine (FHM)?
The answer is A. The SCN1A gene encodes the a: subunit of neuronal voltage-gated sodium (Nayl.l) channels involved in the generation and propagation of action potentials. Multiple SCN1A gene mutations have been associated with different types of epilepsy syndromes. The SCN1A gene mutation, which is associated with familial hemiplegic migraine (FHM) type 3, is the least common FMH-associated gene mutation. Mutations of the CACNA1A and the ATP1A2 genes are associated with familial hemiplegic migraine types 1 and 2 respectively. Patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephal-opathy (CADASIL) have a mutation in the NOTCH3 gene. The TREX1 gene mutation is linked to retinal vasculopathy with cerebral leukodystrophy. (Van den Maagdenberg, Haan, Terwindt, et al., Curr Opin Neurol 2007)
Which of the following is associated with headaches in patients with systemic lupus erythematosus?
A. Raynaud’s phenomenon
B. p2 glycoprotein-I antibodies
D. Active lupus disease
E. All of the above
The answer is E. Headaches in patients with systemic lupus erythematosus are very common. The most common headache type is migraine, which may affect up to half of lupus patients, both adults and children. They are associated with Raynauds phenomenon, p2 glycoprotein-I antibodies, active lupus disease, and depression. (Weder-Cisneros, Tellez-Zenteno, Cardiel, et al., Cephalalgia 2004; Appenzeller & Costallat, Cephalalgia 2004)
Which of the following statements best describes pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis, which is also known as headache with neurological deficits and CSF lymphocytosis (HaNDL)?
A. Visual symptoms occur more frequently than sensory symptoms.
B. Neurological deficits persist between attacks.
C. Spinal fluid protein is rarely elevated.
D. A viral-like illness may precede the onset of symptoms.
E. Patients are more likely to be female.
The answer is D. Headache with neurological deficits and CSF lymphocy-tosis , generally called HaNDL, is most frequent in men between 15 and 40 years of age. About a third of patients with this syndrome have a prior viral-like illness; although its etiology is unknown and viral PCR have not been identified in the CSF. The patients have a dozen or more episodes of neurologic deficits (usually sensory deficits and aphasia with infrequent visual loss) lasting for hours, occurring episodically for up to 3 months. The accompanying headache is generally bilateral and throbbing. Lymphocytes and protein are elevated in the spinal fluid, which does not show any evidence of infection. Between attacks and after the symptomatic period, the patient is without neurological deficits or symptoms. (Gomez-Aranda, Canadillas, Marti-Masso, et al., Brain 1997; Pascual & Valle, Curr Pain Headache Rep 2003)