skip to main content

Migraine without aura — MCCQE Part 1 MCQ

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

HardHeadacheMigraine without auraMCCQE Part 1

A 39-year-old woman with migraine now has headache on 20 days each month. She takes sumatriptan on 14 days monthly and has no new neurologic findings. What is the most appropriate management approach?

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

Reveal the answer and explanation

Correct answer: A — Withdraw the overused triptan and begin suitable migraine prevention

Headache on at least 15 days monthly with triptan use on more than 9 days strongly suggests medication-overuse headache superimposed on migraine. Explain the cycle, plan withdrawal or marked reduction of the overused acute medication, and initiate or optimize prevention according to patient factors. Preventive treatment can begin during withdrawal; care should not be withheld. Opioids and combination analgesics can also cause overuse and introduce additional harms. Future use should generally remain at no more than 9 days monthly for triptans, opioids or combination analgesics and no more than 14 days for simple analgesics.

Reference: NICE CG150, Headaches—Recommendations: https://www.nice.org.uk/guidance/cg150/chapter/recommendations