364.2 🩺 國考版

364.2.1 高頻考點

364.2.1.1 Migraine Without Aura Criteria

  • ≥ 5 attacks
  • 4-72 hr
  • ≥ 2 of: unilateral, pulsating, moderate-severe, aggravated by activity
  • ≥ 1 of: N/V, photo + phono

364.2.1.2 Aura

  • 5-60 min
  • Visual most common
  • Headache within 60 min

364.2.1.3 Triptans Contraindications

  • CAD
  • Uncontrolled HTN
  • Stroke history
  • Hemiplegic/basilar migraine
  • Within 24 hr of ergot

364.2.1.4 CGRP Drugs (Memorize)

Anti-CGRP mAbs (Prevention): - Erenumab (Aimovig) — anti-CGRP-R, SC monthly - Fremanezumab (Ajovy) — anti-CGRP, SC monthly or quarterly - Galcanezumab (Emgality) — anti-CGRP, SC monthly (also cluster) - Eptinezumab (Vyepti) — anti-CGRP, IV quarterly

Gepants: - Acute: ubrogepant, rimegepant, zavegepant (nasal) - Prevention: atogepant, rimegepant

Lasmiditan (Reyvow): ditan, 5HT-1F; no vasoconstriction (safe in CAD)

364.2.1.5 Cluster Acute

  • High-flow O2 (12-15 L/min × 15-20 min)
  • SC sumatriptan 6 mg

364.2.1.6 Cluster Preventive

  • Verapamil (high doses)
  • Galcanezumab (FDA approved)
  • Lithium, topiramate

364.2.1.7 Indomethacin-Responsive Headaches

  • Paroxysmal hemicrania (absolute)
  • Hemicrania continua (absolute)
  • Primary cough, exertional, hypnic

364.2.1.8 GCA

  • Age > 50
  • ↑ ESR/CRP
  • TA biopsy
  • Urgent steroids (don’t wait for biopsy if suspicious)
  • Tocilizumab refractory

364.2.1.9 IIH

  • Young obese women
  • Papilledema
  • LP > 25 cm H2O
  • Acetazolamide

364.2.1.10 Thunderclap Headache

  • < 1 minute to peak
  • Differential:
    • SAH (top priority — rule out)
    • RCVS
    • Cervical artery dissection
    • CVST
    • Pituitary apoplexy
    • PRES
  • CT first, then LP if CT negative (xanthochromia)

364.2.1.11 Medication Overuse Headache

  • Triptans ≥ 10 days/mo
  • Simple analgesics ≥ 15
  • Opioids/combinations ≥ 10
  • Withdrawal + bridge + preventive

364.2.2 Trial Quick Reference

Trial Drug Indication
STRIVE, ARISE, LIBERTY Erenumab Migraine prevention
HALO Fremanezumab Migraine prevention
EVOLVE-1/2, REGAIN Galcanezumab Migraine prevention
PROMISE-1/2 Eptinezumab Migraine prevention
PREEMPT-1/2 OnabotulinumtoxinA Chronic migraine
ACHIEVE-1/2 Ubrogepant Migraine acute
CONQUER Galcanezumab Cluster prevention