Headache IQ


Botox for episodic migraine? Vitamin B for migraine with aura? Best option for acute cluster headache? Take the quiz.


Question 1:

Answer and Question #2 on Next Page »

The correct answer is B. False


According to 2016 guidelines by the American Academy of Neurology, onaBoNT-A is not effective in treating episodic migraine and should not be used for this purpose (Level A recommendation). This is because different botox formulations have important pharmacologic differences, and vary by potency and duration of action. Currently 4 botox preparations have been approved by the FDA, and current evidence does not support use of any for episodic migraine.1



Question 2:

Answer and Question #3 on Next Page »

The correct answer is D. All of the above


Work by the Genomics Research Centre suggests that combined treatment with 400 µg vitamin B12, 25 mg vitamin B6, and 2 mg folic acid daily for 6 months is associated with significant decreases in symptoms of migraine with aura, compared to placebo. The treatment effect may be related to decreased homocysteine levels in response to vitamin supplementation.2, 3




Question 3:




Answer on Next Page »

The correct answer is D. A and C


According to 2016 guidelines from the American Headache Society, subcutaneous sumatriptan, zolmitriptan nasal spray, and high flow oxygen are evidence-based treatments for acute cluster headache (Level A recommendation). There is insufficient evidence to support the use of capsaicin in cluster headache.4



1. Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: Botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2016 May 10;86:1818-1826. http://www.neurology.org/content/86/19/1818.full

2. Lea R, Colson N, Quinlan S, et al. The effects of vitamin supplementation and MTHFR (C677T) genotype on homocysteine-lowering and migraine disability. Pharmacogenet Genomics. 2009;19:422-448. https://www.ncbi.nlm.nih.gov/pubmed/19384265

3. Menon S, Lea RA, Roy B, et al. Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation. Pharmacogenet Genomics. 2012;22:741-749. https://www.ncbi.nlm.nih.gov/pubmed/22926161

4. Robbins MS, Starling AJ, Pringsheim TM, et al. Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. Headache. 2016 Jul;56(7):1093-1096. http://onlinelibrary.wiley.com/doi/10.1111/head.12866/full

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