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Acephalgic Migraine — SCE Neurology MCQ

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HardHeadache & Facial PainAcephalgic MigraineSCE Neurology

A 45-year-old woman presents with migraine aura without headache: 20-minute scintillating scotomata expanding across her visual field, then complete resolution. No headache. History of migraine with aura. MRI normal. What is the management?

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

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Correct answer: D — Reassurance — migraine aura without headache; consider prophylaxis if frequent

The best answer is “Reassurance — migraine aura without headache; consider prophylaxis if frequent”. Primary headache diagnosis follows attack phenotype and absence of secondary red flags; acute and preventive treatment is selected by headache type, frequency, disability and contraindications. The alternatives “Urgent CTA, after excluding important mimics, after specialist assessment”, “DOAC, after specialist assessment, when the phenotype supports it”, “Carbamazepine, when the phenotype supports it, within the relevant UK pathway”, “Carotid Doppler, within the relevant UK pathway, after excluding important mimics” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE CG150 headache recommendations: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations