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Migraine Without Aura — SCE Neurology MCQ

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EasyHeadache & Facial PainMigraine Without AuraSCE Neurology

A 40-year-old woman presents with a 6-month history of severe unilateral left-sided headaches lasting 4–72 hours, pulsating in quality, associated with nausea, photophobia, and phonophobia. She has 12 headache days per month. Simple analgesics and a triptan provide partial relief. She has not tried prophylaxis. What is the most appropriate first-line prophylactic treatment per NICE guidelines?

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Correct answer: C — Propranolol

For episodic migraine prophylaxis, NICE CG150 recommends topiramate or propranolol as first-line options. This patient has high-frequency episodic migraine (12 days/month, just below chronic migraine threshold of 15 days). Propranolol and topiramate are equally recommended. A: Topiramate is also first-line but requires a Pregnancy Prevention Programme in women of childbearing potential per MHRA 2024 guidance. C: Amitriptyline is commonly used but is second-line per NICE. D: Valproate is not recommended for migraine prophylaxis in women of childbearing potential. E: Botulinum toxin is for chronic migraine (≥15 days/month for ≥3 months).

Reference: NICE CG150 Headaches (2012, updated 2021)