WorksheetsMigraine Headaches Quiz
Total questions: 99
Worksheet time: 50mins
What is the main focus of the systematic review and meta-analysis discussed in the document?
Cognitive Behavioral Therapy for Migraine Headache
Treatment of diabetes with medication
Surgical interventions for chronic pain
Nutritional therapy for obesity
Which of the following is NOT a typical symptom associated with migraine headaches as mentioned in the document?
Nausea
Photophobia
Joint pain
Phonophobia
According to the document, what is the estimated prevalence of migraine in the population?
15–18%
1–5%
25–30%
40–50%
Which gender is more likely to experience migraines, based on the information provided?
Women
Men
Both equally
Children only
What is the primary outcome measured in the studies included in the review?
Frequency of migraines and the intensity of migraines
Blood pressure levels
Cholesterol levels
Weight loss
Which assessment tools were used to measure the impact of migraines in the studies?
Visual Analog Scale (VAS), Migraine Disability Assessment (MIDAS), and Headache Impact Test (HIT-6)
Body Mass Index (BMI) and Blood Sugar Test
Electrocardiogram (ECG) and MRI
Sleep Quality Index and Lung Function Test
What was a significant finding regarding headache frequency and MIDAS scores in the meta-analysis?
They were statistically significantly reduced
They increased significantly
They remained unchanged
They were not measured
Which of the following is a potential adverse effect reported in the subgroup analysis of CBT for migraine?
Worsening of migraine intensity and frequency
Improved memory
Increased appetite
Weight gain
How many randomized controlled trials (RCTs) were included in the systematic review?
11
5
25
50
Which countries were mentioned as locations where the included RCTs were conducted?
USA, UK, Germany, Iran, Italy
China, Japan, Brazil, Australia, Canada
Russia, India, South Africa, Mexico, Spain
France, Sweden, Norway, Denmark, Finland
Which of the following is NOT recommended as a routine acute medication for migraine due to poor safety and tolerability?
Paracetamol
Non-steroidal anti-inflammatory drugs (NSAIDs)
Triptans
Opioids and barbiturates
What is a major concern associated with the overuse of painkillers in migraine treatment?
Increased effectiveness of medication
Medication overuse headache and side effects
Improved quality of life
Reduced need for non-drug therapy
Which of the following therapies is known to have fewer side effects and can be used simultaneously with medications for migraine?
Non-drug therapy
Opioid therapy
Barbiturate therapy
Triptan therapy
Which of the following is a preventive treatment for migraine that uses cognitive factors to improve mental disorders and psychological distress?
Acupuncture
Cognitive behavioral therapy (CBT)
Vitamin D supplementation
Triptan administration
Which statement best describes the current evidence for the use of CBT in pediatric migraine, according to the text?
There are many systematic reviews on pediatric migraine and CBT.
There is only one systematic review on pediatric migraine and CBT.
CBT is not effective for pediatric migraine.
CBT is only recommended for adults with migraine.
Why do the authors emphasize the need for randomized controlled trials (RCTs) in the study of CBT for migraine?
To increase the use of medication in migraine treatment
To evaluate the clinical efficacy and safety of CBT on migraine patients of all ages
To discourage the use of non-drug therapies
To promote the use of opioids and barbiturates
Based on the text, which of the following is a reason for using nutritional supplements such as riboflavin, pyridoxine, folate, cobalamin, and vitamin D in migraine treatment?
They are used as acute medications for immediate relief.
They are widely used as preventive treatments for migraine.
They are only used in pediatric patients.
They are preferred over cognitive behavioral therapy.
Which databases were searched by the authors to evaluate the efficacy of CBT for migraine?
Only PubMed and Embase
Only Chinese and Korean databases
MEDLINE, PubMed, Embase, Cochrane, CNKI, RISS, Oasis, KISS, NDSL, DBPIA
Only Cochrane Central Register of Controlled Trials
Which types of studies were included in the review according to the eligibility criteria?
RCTs and quasi-RCTs
Case reports and cohort studies
Cross-sectional and case-control studies
Meta-analyses and systematic reviews
What was the primary outcome measure for migraine in the review?
Frequency of migraine per month
Type of medication used
Patient age
Country of origin
Which diagnostic criteria were used to include participants with migraine in the review?
ICHD (II, III) and IHS criteria
DSM-5 criteria
ICD-10 criteria only
NIH guidelines
Which of the following is NOT listed as a primary outcome measure in the review?
Blood pressure levels
Headache days assessed by diary
Headache duration and pain intensity
Migraine Disability Assessment (MIDAS)
How was the impact of headache assessed in the included studies?
By using the Headache Impact Test (HIT-6)
By measuring blood glucose levels
By recording sleep patterns
By counting hospital visits
Why might the authors have contacted the authors of the included studies?
To clarify missing or unclear results
To request funding
To recruit more participants
To change the study design
Why is it important to use standardized diagnostic criteria, such as ICHD and IHS, in a systematic review of migraine studies?
It increases the number of participants.
It ensures consistency and comparability across studies.
It allows for more subjective interpretation.
It reduces the cost of the review.
Which of the following was an inclusion criterion for the Powers (2020, USA) study?
ICHD-II with ≤15 days headache per month
Age 18–65 years
Continuous headache over 30 days
Use of disallowed medications
What was the intervention used in the Seng (2019, USA) study?
MBCT-M
Amitriptyline
CBT
Education only
Which of the following was an exclusion criterion common to both studies listed in the table?
Severe psychiatric illness
Age under 18 years
Headache days ≥ 6 per month
Ability to read English
In the Powers (2020, USA) study, what was the duration of the intervention?
20 weeks
8–10 weeks
4 months
6 months
Which study required participants to have the ability to read English as an inclusion criterion?
Seng (2019, USA)
Powers (2020, USA)
Both studies
Neither study
Based on the table, which of the following best describes the control group in the Powers (2020, USA) study?
Amitriptyline only
MBCT-M
WL/TAU
No intervention
If a participant in the Seng (2019, USA) study was unable to adhere to a headache diary (recorded <26/30 days), what would happen?
They would be excluded from the study.
They would be placed in the intervention group.
They would receive additional education.
They would be given amitriptyline.
Which of the following is a difference in the age of participants between the two studies?
Powers (2020, USA) included younger participants than Seng (2019, USA).
Seng (2019, USA) included only participants under 18.
Both studies included participants aged 14.
Powers (2020, USA) included only participants over 40.
Which study listed in the table included participants with high-frequency migraine without aura according to the IHS-beta-2013 criteria?
Grazzi (2019, Italy&USA)
Mansourishad (2017, Iran)
Smitherman (2016, USA)
None of the above
What was the exclusion criterion for the Mansourishad (2017, Iran) study?
Severe physical illness
High-frequency migraine
Chronic migraine comorbid insomnia
Minimum of moderate IQ
Which intervention was used in the Smitherman (2016, USA) study for chronic migraine comorbid insomnia?
CBTi
MBCT
ACT + Education + Prophylaxis
Education + Prophylaxis
For the Grazzi (2019, Italy&USA) study, what was the duration of the intervention?
6 weeks
12 weeks
2 weeks
8 months
Which of the following was NOT an exclusion criterion for the Smitherman (2016, USA) study?
Minimum of moderate IQ
Active alcohol or substance use or dependence
Active bipolar disorder
Untreated sleep apnea
In the Mansourishad (2017, Iran) study, which of the following was an inclusion criterion?
Minimum of moderate IQ
Pregnancy or breastfeeding
Active bipolar disorder
Employment involving rotating shift work schedule
What was the follow-up period for the Grazzi (2019, Italy&USA) study?
3, 6, 12 months
2, 6 weeks after Tx
6 weeks
8 months
Which study required participants to be female as part of the inclusion criteria?
Mansourishad (2017, Iran)
Grazzi (2019, Italy&USA)
Smitherman (2016, USA)
None of the above
Which study used MBCT as the intervention?
Mansourishad (2017, Iran)
Grazzi (2019, Italy&USA)
Smitherman (2016, USA)
None of the above
What was a unique exclusion criterion for the Grazzi (2019, Italy&USA) study?
None
Severe physical illness
Active bipolar disorder
Unwillingness to continue treatment
Which of the following was an exclusion criterion in the Cousins (2015, UK) study on headache interventions?
Secondary HA (physical conditions likely to cause HA)
Onset >6 months ago
HA days per month assessed by HA diary
IHS 2nd criteria with or without aura
What was the intervention used in the Rapoff (2014, USA) study for migraine in children?
CBT + Relaxation
CD-Rom Headstrong
SMC
MBSR
According to the Wells (2014, USA) study, which of the following was NOT an inclusion criterion?
Migraine days/month between 2–14
≥1 year history of migraines
Current regular meditation/yoga
≥18 years old
In the Cousins (2015, UK) study, what was the duration of the intervention?
4 weeks
5 weeks
8 weeks
3 months
Which study included participants with an average age of approximately 10 years?
Cousins (2015, UK)
Rapoff (2014, USA)
Wells (2014, USA)
None of the above
What was a follow-up period used in the Cousins (2015, UK) study?
2, 4 months
3 months
8 weeks
4 weeks
Which of the following was an exclusion criterion in the Wells (2014, USA) study?
Migraine w or w/o aura
Current/planned pregnancy or breastfeeding
≥18 years old
≥1 year history of migraines
What type of study design was used in all three studies listed in the table?
Case-control study
Randomized Controlled Trial (RCT)
Cohort study
Cross-sectional study
Which of the following was an exclusion criterion in the Fritche (2010, Germany) study?
Significant psychiatric disorder
Migraine with aura
Age 18-65 years
Combined headache
What was the intervention used in the Calhoun (2007, USA) study?
BSM (Biofeedback and Stress Management)
MCT (Minimal Contact Training)
CBT (Cognitive Behavioral Therapy)
Pharmacological treatment
According to the Scarff (2002, USA) study, what was one of the inclusion criteria for participants?
Average migraine ≥1 per week or ≥5 days per month
Significant psychiatric disorder
Pregnancy
Diagnosis of a primary sleep disorder
In the Fritche (2010, Germany) study, what was the minimum and maximum number of triptan intake days allowed for inclusion?
More than 4 and less than 10 days per month
More than 10 and less than 20 days per month
Less than 4 and more than 15 days per month
Exactly 9 days per month
Which study listed “Non-pregnant” as an exclusion criterion?
Calhoun (2007, USA)
Fritche (2010, Germany)
Scarff (2002, USA)
None of the above
What was the follow-up duration for the Scarff (2002, USA) study?
3, 6 months
3, 12–30 months
6, 12 weeks
5 weeks
Which of the following is NOT an exclusion criterion in the Fritche (2010, Germany) study?
Combined headache
Pregnancy
Significant psychiatric disorder
Insufficient knowledge of the German language
What was the control group in the Calhoun (2007, USA) study?
Sham control (Placebo behavioral group)
Bibliotherapy (information brochures)
Wait-list control
No control group
Which of the following is a key component of the CBT method used by Powers (2020, USA) for pediatric pain?
Mindful movement and stretching
Biofeedback component with thermal and electromyographic monitoring
Creative helplessness exercises
Pharmacological prophylaxis
What is the main focus of the MBCT protocol as described by Seng (2019, USA)?
Developing nonjudgmental thinking
Practicing mindfulness and cognitive therapy for migraine management
Using pharmacological prophylaxis for migraine
Discussing headache-related education topics
Which session in the ACT protocol by Grazzi (2019, Italy&USA) focuses on "Actions guided by values; working with thoughts"?
Session 1
Session 2
Session 3
Session 5
According to the table, what is a common element in the MBSR protocol described by Mansourabadi (2017, Iran)?
Use of pharmacological agents
Homework assignments with guided audio for daily mindfulness meditation
Biofeedback monitoring
Creative helplessness exercises
Which of the following best describes the objective of ACT as used in the studies?
To provide pharmacological treatment for migraine
To train patients in mindfulness and pain management by cultivating psychological flexibility
To monitor relaxation response using biofeedback
To focus on nonjudgmental awareness only
A patient is asked to practice "Sitting meditation and mindful movement" as homework. Which CBT method does this most likely belong to?
ACT
MBCT
MBSR
Education
If a study's method includes "Education of patients, followed by pharmacological prophylaxis for migraine," which treatment is being described?
MBCT
ACT
Education
MBSR
Which of the following is NOT a focus of the MBSR protocol as described in the table?
Nonjudgmental thinking
Present-moment awareness
Pharmacological intervention
Mindfulness meditation practices
Which of the following is a key instruction for managing insomnia according to the CBTi method described by Smitherman (2016, USA)?
Go to bed only when sleepy and intending to sleep.
Drink coffee before bedtime to relax.
Exercise vigorously right before sleeping.
Eat a heavy meal late at night.
According to the Sham control group in Smitherman (2016, USA), which of the following is NOT part of the lifestyle modification instructions?
Eat dinner at a consistent time every evening.
Do acupressure at least 2 minutes twice daily.
Consume at least one serving of protein within one hour of arising in the morning.
Take a nap every afternoon.
Which of the following is a component of sleep hygiene as described in the CBTi method?
Limiting caffeine and meals prior to bedtime.
Increasing screen time before bed.
Sleeping in a noisy environment.
Skipping breakfast.
In the Cousins (2015, UK) study, what is introduced in Week 1 of the CBT + Relaxation treatment?
Introducing the concept of links between thoughts, feelings, symptoms, and behaviors.
Telephone follow up and review of progress.
Building on alternative thinking techniques.
Reviewing headache/thought diaries.
Why is it important to set an alarm and rise daily at the same time according to the CBTi method?
To regulate sleep patterns and reinforce a consistent sleep schedule.
To allow for more time to watch TV in the morning.
To ensure you can skip breakfast.
To increase caffeine intake.
Which of the following is an example of cognitive restructuring as described in the Cousins (2015, UK) study?
Building on alternative thinking techniques.
Eating dinner at a consistent time.
Recording all liquids consumed.
Doing 5 minutes of stretching upon awakening.
Which of the following is a key component of the MBSR protocol as described by Dr. Jon Kabat-Zinn?
Progressive muscle relaxation
Mindfulness of breathing, mindful eating, and the body scan
Cognitive restructuring
Medication rules and the risk of medication overuse
During which week of the I: Headstrong intervention is relaxation, including guided imagery and deep breathing, primarily taught?
Week 1
Week 2
Week 3
Week 4
What is the main focus of Week 4 in the C: Education intervention for headache management?
Introduction to headache education
Cognitive-behavioral model of pain
Headache triggers, including diet and sleep
Relaxation techniques
Which unit in the MCT intervention by Fritche (2010, Germany) is aimed at raising awareness for external and internal influences on medication intake behavior?
Unit 1: Introduction and syndrome education
Unit 2: Medication rules and the risk of Medication Overuse Headache
Unit 3: Medication intake behavior
Unit 4: General and personal risk factors for drug intake
Why is a daily headache diary used in the MCT intervention?
To record medication side effects
To track daily PMR and headache occurrences, and to support behavioral change
To monitor dietary habits
To assess cognitive restructuring progress
(DoK Level 2) How does the C: Education intervention incorporate the cognitive-behavioral model of pain into its weekly structure?
By teaching only relaxation techniques
By introducing the pain puzzle and discussing feelings and behavior in weeks 2 and 3
By focusing solely on medication management
By providing only information about headache triggers
(DoK Level 3) If a patient is struggling with medication overuse headache, which units of the MCT intervention would be most relevant for their education and behavioral change, and why?
Units 1 and 2, because they provide syndrome education and information about medication rules and risks
Units 3 and 4, because they focus on medication intake behavior and risk factors
Units 5 and 6, because they address everyday transfer and diary keeping
Units 2 and 3, because they address medication rules, risk of overuse, and intake behavior
Which of the following is a method used in Behavioral Sleep Modification (BSM) instructions according to Calhoun (2007, USA)?
Schedule consistent bedtime that allows 8 hours in bed
Perform acupressure for 2 minutes twice daily
Cognitive behavioral stress management training
Thermal biofeedback training
What is one of the methods used in Sham Instructions as per Calhoun (2007, USA)?
Use visualization technique to shorten time to sleep onset
Record liquid consumption for 3 consecutive days
Progressive muscle relaxation
Eliminate TV, reading, music in bed
Which of the following is NOT a method listed under Scarff (2002, USA) for cognitive behavioral stress management training?
Progressive muscle relaxation
Instruction in deep breathing techniques
Discontinue naps
Imagery training of warm places and vasodilation
According to Scarff (2002, USA), what were younger children taught in cognitive behavioral stress management training?
Stopping and positive self-statements
Visualization technique to shorten time to sleep onset
Record liquid consumption for 3 consecutive days
Have 1 protein serving at breakfast
Which method is shared between the treatments described by Calhoun (2007, USA) and Scarff (2002, USA)?
Progressive muscle relaxation
Schedule consistent bedtime
Use of acupressure
Hand-warming biofeedback training
Which tool was used for quality assessment of the included studies in the review?
The Cochrane risk of bias (ROB) assessment tool
The Jadad scale
The Newcastle-Ottawa Scale
The GRADE system
How many domains were assessed in the risk of bias evaluation?
Seven
Five
Three
Nine
What statistical measure was used to assess heterogeneity in the meta-analysis?
I² statistics
Chi-square test
Pearson correlation
T-test
According to the text, what happens if I² is greater than 75% in the meta-analysis?
The random effect model is used
The fixed effect model is used
The study is excluded
The data is re-collected
What was the total number of patients with migraine analyzed in the review?
621
317
304
233
Which countries were the four RCTs, other than those from the USA, conducted in?
UK, Italy, Germany, and Iran
France, Spain, Canada, and Japan
Australia, China, Brazil, and India
Russia, Sweden, Mexico, and South Africa
What were the two types of control groups described in the included studies?
Conventional therapy (no treatment/TAU) and sham control (lifestyle modification with placebo behavioral therapy)
Drug therapy and surgery
Physical therapy and dietary intervention
Homeopathy and acupuncture
Which criteria did five of the included trials use for migraine diagnosis?
ICHD-II criteria
DSM-5 criteria
ICHD-III criteria
ICD-10 criteria
What is the main purpose of subgroup analysis in this review?
To explain the source of heterogeneity
To increase the sample size
To reduce the number of studies
To change the intervention
Why were 178 articles assessed for eligibility after the initial screening?
Because 55 articles without full text were removed
Because they were all RCTs
Because they were all from the same country
Because they all used the same intervention
Which database contributed the highest number of records identified in the data selection process?
MEDLINE
Embase
CENTRAL
CNKI
How many records were identified through database searching in total?
373
233
178
109
At which stage were articles excluded for being Non-CBT or not RCTs?
Identification
Screening
Eligibility
Included
How many studies were included in the final quantitative analysis?
373
178
11
55
