Refractory Chronic Migraine — RACP Adult Medicine MCQ
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Correct answer: B — CGRP monoclonal antibody (erenumab)
Chronic migraine (≥15 headache days/month, ≥8 with migraine features) refractory to ≥3 standard preventers is an indication for CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab) per PBS criteria in Australia. The medication-overuse headache (from codeine) must also be addressed with withdrawal and patient education. Opioids should be ceased.
Reference: eTG Neurology – 2024 – Migraine; Headache Australia 2024; PBS