skip to main content

Chronic Migraine — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeurologyChronic MigraineRACP Adult Medicine

A 42-year-old woman with chronic migraine has failed multiple preventive therapies including topiramate, propranolol, and amitriptyline. She has >15 headache days per month with >8 meeting migraine criteria. What is the most appropriate next-line preventive therapy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Botulinum toxin A (onabotulinumtoxinA) injections

For chronic migraine (≥15 headache days/month, ≥8 with migraine features, for >3 months) refractory to ≥3 oral preventives, botulinum toxin A (onabotulinumtoxinA – PREEMPT protocol) is recommended. It involves injection of 155–195 units across 31–39 sites in the head and neck every 12 weeks. CGRP monoclonal antibodies (erenumab, galcanezumab, fremanezumab) are alternative PBS-listed options for chronic migraine that has failed ≥3 preventives.

Reference: eTG – 2025 – Neurology; Headache Australia – 2024 – Migraine Prevention Guidelines