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Migraine Prevention — MRCGP AKT MCQ

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HardNeurologyMigraine PreventionMRCGP AKTUKMLA

A patient has four disabling migraines each month. Propranolol, topiramate and amitriptyline have each been tried adequately but were ineffective or not tolerated. She prefers a non-drug option before specialist injectable treatment. Which intervention should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Up to 10 sessions of acupuncture over 5 to 8 weeks

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

A is correct. NICE recommends considering a course of up to 10 acupuncture sessions over 5 to 8 weeks for migraine prevention when propranolol, topiramate and amitriptyline are unsuitable or ineffective. The stem explicitly establishes that all three usual oral preventive options have been addressed. Opioids and corticosteroids are not preventive migraine strategies and expose the patient to substantial harm. Routine neck manipulation is not the guideline-listed next option. Acute medicines should be reviewed for medication-overuse risk, but they are not automatically stopped regardless of frequency, and preventive benefit should be reviewed after an appropriate interval.

Reference: NICE CG150, recommendation 1.3.20: https://www.nice.org.uk/guidance/cg150/chapter/recommendations