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DVT — UKMLA MCQ

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HardHaematologyDVTUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 38-year-old with migraine now has near-daily headache after taking sumatriptan on 14 days and paracetamol on 18 days each month for 5 months. There is no opioid use, major comorbidity or previous withdrawal attempt. What is the best initial management of the medication-overuse component?

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Correct answer: A — Abruptly stop both overused medicines for at least 1 month

The best answer is “Abruptly stop both overused medicines for at least 1 month”. Both the triptan and simple analgesic exceed their medication-overuse thresholds. NICE advises stopping every overused acute headache medicine for at least 1 month and doing so abruptly, warning that headache may initially worsen and providing close support. Preventive migraine therapy can be considered alongside withdrawal. Selective withdrawal leaves an overused medicine in place; codeine perpetuates medication overuse, and inpatient withdrawal is not routine without strong-opioid use, relevant comorbidity or repeated failed attempts.

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