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MND – PEG Timing — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularMND – PEG TimingSCE Neurology

A patient with chronic migraine uses triptans on 16 days each month and headache frequency has progressively increased. Which first management step addresses the likely perpetuating mechanism?

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Correct answer: D — Explain medication-overuse headache and plan supported withdrawal of the overused acute medicine

The best answer is “Explain medication-overuse headache and plan supported withdrawal of the overused acute medicine”. Frequent triptan exposure can perpetuate chronic headache; supported withdrawal plus preventive strategy is central. “Escalate triptan use to daily prophylaxis” can be reasonable in another presentation, but it does not account for the defining feature here. “Add an opioid for non-triptan days” can be reasonable in another presentation, but it does not account for the defining feature here. “Order serial lumbar punctures” can be reasonable in another presentation, but it does not account for the defining feature here. “Stop preventive treatment until withdrawal is complete” can be reasonable in another presentation, but it does not account for the defining feature here.

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