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CGRP Antibodies – NICE Eligibility Criteria — SCE Neurology MCQ

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HardHeadache & Facial PainCGRP Antibodies – NICE Eligibility CriteriaSCE Neurology

An adult has eight migraine days each month despite adequate trials of three suitable preventive medicines that were ineffective or intolerable. What NICE pathway option is now reasonable?

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Correct answer: D — Consider a NICE-recommended CGRP-targeted preventive, after confirming the indication

The best answer is “Consider a NICE-recommended CGRP-targeted preventive, after confirming the indication”. NICE positions CGRP-targeted prevention after at least three suitable preventive failures; individual technology appraisals specify frequency and response thresholds. “Use a CGRP medicine only after exactly five failures” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat with daily opioids before targeted prevention” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Exclude targeted treatment because migraine is episodic” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Prescribe without documenting migraine frequency or prior treatment” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

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