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Chronic Migraine Prevention — RACP Adult Medicine MCQ

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ModerateNeurologyChronic Migraine PreventionRACP Adult Medicine

A 42-year-old woman presents with episodic severe headaches lasting 4–72 hours, associated with unilateral throbbing pain, nausea, photophobia, and phonophobia. She has 10 headache days per month and is using sumatriptan 8–10 times per month. She is not on preventive therapy. What is the most appropriate management change?

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Correct answer: C — Start propranolol preventive therapy

Migraine with ≥4 headache days/month or significant disability warrants preventive therapy. First-line preventers include propranolol, amitriptyline, topiramate, and candesartan. With 10 days/month of triptan use, there is risk of medication-overuse headache. The triptan frequency must be reduced while introducing a preventer. Propranolol is a well-established first-line option.

Reference: eTG Neurology – 2024 – Migraine Prevention; AAN 2024