Headache disorders: pharmacological approaches MCQs With Answer

Introduction: This quiz collection focuses on pharmacological approaches to headache disorders tailored for M.Pharm students studying Pharmacotherapeutics II (MPP 202T). The questions cover mechanisms of action, indications, contraindications, adverse effects, drug interactions, and clinical choices for acute and preventive treatment of migraine, cluster, and tension-type headaches. Emphasis is placed on contemporary therapies including triptans, ergots, CGRP monoclonal antibodies, gepants, ditans, and onabotulinumtoxinA, as well as practical considerations such as pregnancy, comorbidities, and medication-overuse headache. These MCQs are designed to deepen understanding of pharmacology and clinical decision-making for advanced pharmacy practice.

Q1. Which mechanism best describes the action of triptans in acute migraine therapy?

• 5-HT1B/1D receptor agonism causing cranial vasoconstriction and inhibition of neuropeptide release
• Nonselective COX inhibition reducing prostaglandin synthesis
• CGRP ligand neutralization in the bloodstream
• Voltage-gated sodium channel blockade in peripheral nerves

Correct Answer: 5-HT1B/1D receptor agonism causing cranial vasoconstriction and inhibition of neuropeptide release

Q2. Which condition is an absolute or strong contraindication to the use of triptans?

• Uncontrolled ischemic heart disease or recent myocardial infarction
• Well-controlled hypothyroidism
• Mild renal impairment (eGFR 50–60 mL/min)
• Episodic tension-type headache

Correct Answer: Uncontrolled ischemic heart disease or recent myocardial infarction

Q3. Which approved monoclonal antibody targets the CGRP receptor rather than the CGRP ligand?

• Fremanezumab
• Galcanezumab
• Erenumab
• Eptinezumab

Correct Answer: Erenumab

Q4. Gepants (e.g., ubrogepant) exert their antimigraine effect primarily by which mechanism?

• 5-HT1F receptor agonism
• CGRP receptor antagonism
• Dopamine D2 receptor blockade
• Calcitonin receptor activation

Correct Answer: CGRP receptor antagonism

Q5. For a patient presenting with moderate to severe acute migraine without contraindications, which drug class is considered first-line abortive therapy?

• Beta-adrenergic blockers
• Triptans (serotonin 5-HT1B/1D agonists)
• Antiepileptics used as prophylaxis
• Botulinum toxin injections

Correct Answer: Triptans (serotonin 5-HT1B/1D agonists)

Q6. OnabotulinumtoxinA (Botox) is specifically approved for which headache indication?

• Chronic migraine (≥15 headache days/month)
• Episodic migraine (<15 days/month)
• Acute cluster headache attack
• Acute tension-type headache

Correct Answer: Chronic migraine (≥15 headache days/month)

Q7. Which acute treatment is first-line for aborting an active cluster headache attack in the outpatient setting?

• High-flow 100% oxygen by non-rebreather mask
• Oral naproxen sodium
• Daily propranolol
• Subcutaneous onabotulinumtoxinA

Correct Answer: High-flow 100% oxygen by non-rebreather mask

Q8. Which preventive migraine therapy is preferred in a patient with comorbid hypertension?

• Amitriptyline
• Propranolol
• Topiramate
• Sumatriptan

Correct Answer: Propranolol

Q9. Lasmiditan, a newer acute migraine agent, produces analgesia predominantly via which receptor?

• 5-HT1F receptor agonism with minimal vasoconstriction
• 5-HT1B/1D receptor agonism causing cranial vasoconstriction
• CGRP ligand neutralization
• Peripheral opioid receptor agonism

Correct Answer: 5-HT1F receptor agonism with minimal vasoconstriction

Q10. Which prophylactic migraine medication is believed to reduce cortical spreading depression and neuronal hyperexcitability?

• Propranolol
• Topiramate
• Sumatriptan
• Metoclopramide

Correct Answer: Topiramate

Q11. The most clinically significant adverse effects associated with topiramate in migraine prophylaxis include which of the following?

• Cognitive impairment (word-finding difficulty), paresthesias, and increased risk of nephrolithiasis
• Severe bradycardia and hypotension
• Major hepatotoxicity with routine monitoring required
• Extrapyramidal symptoms and tardive dyskinesia

Correct Answer: Cognitive impairment (word-finding difficulty), paresthesias, and increased risk of nephrolithiasis

Q12. Ergotamine toxicity (ergotism) is primarily characterized by which pathophysiologic process?

• Excessive systemic vasoconstriction causing ischemia of peripheral tissues
• Immune-mediated thrombocytopenia
• Direct renal tubular necrosis
• Serotonin receptor blockade leading to hypotension

Correct Answer: Excessive systemic vasoconstriction causing ischemia of peripheral tissues

Q13. Which triptan has the longest plasma half-life and is often used for prolonged or menstrual migraines?

• Sumatriptan
• Rizatriptan
• Frovatriptan
• Eletriptan

Correct Answer: Frovatriptan

Q14. Which antiemetic with dopamine antagonist activity is commonly used as an adjunct in acute migraine to improve gastric emptying and analgesic absorption?

• Ondansetron
• Metoclopramide
• Loperamide
• Scopolamine

Correct Answer: Metoclopramide

Q15. During pregnancy, which acute pain reliever is generally recommended as first-line for migraine?

• Sumatriptan orally as first-line
• Acetaminophen (paracetamol) as preferred first-line
• Ergotamine preparations
• Prophylactic topiramate for acute attacks

Correct Answer: Acetaminophen (paracetamol) as preferred first-line

Q16. Which prophylactic migraine medication carries a high risk of teratogenicity and should be avoided in women of childbearing potential unless absolutely necessary?

• Valproate (sodium valproate)
• Propranolol
• Amitriptyline
• Fremanezumab

Correct Answer: Valproate (sodium valproate)

Q17. The primary molecular action of onabotulinumtoxinA in chronic migraine treatment is:

• Cleavage of SNAP-25 protein at presynaptic terminals, inhibiting neurotransmitter and neuropeptide release
• Direct antagonism of CGRP receptors on trigeminal ganglion cells
• Systemic immunosuppression reducing neuroinflammation
• Blockade of peripheral opioid receptors

Correct Answer: Cleavage of SNAP-25 protein at presynaptic terminals, inhibiting neurotransmitter and neuropeptide release

Q18. Which oral medication is an FDA-approved gepant for the acute treatment of migraine?

• Erenumab
• Ubrogepant
• Fremanezumab
• Sumatriptan

Correct Answer: Ubrogepant

Q19. Which agent is considered first-line for preventive therapy of cluster headache?

• Verapamil
• Topiramate
• Amitriptyline
• OnabotulinumtoxinA

Correct Answer: Verapamil

Q20. Medication-overuse headache (MOH) is most commonly associated with which usage pattern?

• Frequent use of triptans or combination analgesics on more than 10–15 days per month
• Weekly prophylactic injection of onabotulinumtoxinA
• Once-monthly CGRP monoclonal antibody injection
• Occasional oxygen therapy for cluster attacks

Correct Answer: Frequent use of triptans or combination analgesics on more than 10–15 days per month

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