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Bipolar Disorder — UKMLA MCQ

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MediumMental Health & PsychiatryBipolar DisorderUKMLAMRCGP AKTMRCP Part 1

A 38-year-old woman with migraine has developed near-daily headache while taking sumatriptan on 18 days each month for four months. Neurological examination is normal and there are no secondary-headache red flags. What is the best initial management of the medication-overuse component?

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Correct answer: A — Explain the diagnosis and stop the overused triptan abruptly with support and follow-up

Frequent triptan use for more than three months with worsening headache is consistent with medication-overuse headache. Explain that treatment requires withdrawal and advise stopping the overused triptan abruptly for at least a month, warning that headache may worsen temporarily and providing close support and follow-up. Opioid substitution perpetuates overuse, and triptans are not taken daily as prevention. Preventive migraine treatment can be considered alongside the withdrawal plan. Imaging is not indicated solely for frequency when examination and red-flag assessment are reassuring.

Reference: NICE. CG150 Headaches in over 12s: diagnosis and management, recommendations. https://www.nice.org.uk/guidance/cg150/chapter/recommendations