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Migraine Prophylaxis — RACP Paediatrics MCQ

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ModerateNeurology & DevelopmentMigraine ProphylaxisRACP Paediatrics

A 7-year-old boy presents with chronic headaches occurring 4-5 times per month, each lasting 2-4 hours. They are unilateral, throbbing, associated with nausea and photophobia, and relieved by sleep. What is the first-line prophylactic medication if lifestyle measures fail?

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Correct answer: E — Propranolol

For paediatric migraine prophylaxis when lifestyle measures (regular sleep, hydration, exercise, stress management, trigger avoidance) are insufficient, propranolol and amitriptyline are commonly used first-line agents. Topiramate and flunarizine are alternatives. The evidence base for prophylaxis in children is weaker than in adults.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Migraine Prophylaxis