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Cluster vs PH — SCE Neurology MCQ

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HardHeadache & Facial PainCluster vs PHSCE Neurology

A patient with 10 episodic migraine attacks per month starts preventive rimegepant after three failed preventives. At 12 weeks attacks average 6 per month. What is the NICE-concordant decision?

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Correct answer: C — Stop preventive rimegepant because the 40% reduction does not reach 50%

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

D is correct: the fall from 10 to 6 is 40%; NICE TA906 requires at least a 50% reduction in episodic migraine attacks after 12 weeks. A imports the chronic-migraine threshold. B is wrong because TA906 preventive use is for episodic migraine and significance alone does not override the response rule. C invents a rescue period and schedule. E uses the wrong outcome measure.

Reference: NICE TA906: rimegepant for preventing migraine: https://www.nice.org.uk/guidance/ta906/chapter/1-Recommendations