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Migraine with aura — SCE Neurology MCQ

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ModerateHeadacheMigraine with auraSCE Neurology

A 36-year-old man presented with recurrent unilateral throbbing headache preceded by gradually spreading zig-zag visual symptoms. On examination, examination between attacks was normal. Initial investigations showed: MRI performed for atypical first presentation was normal. What is the most appropriate management?

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Correct answer: A — A triptan plus NSAID or paracetamol for acute attacks

A triptan plus NSAID or paracetamol for acute attacks is the best answer because the vignette describes Migraine with aura: gradual positive visual aura followed by migrainous headache supports migraine with aura. High-dose glucocorticoids with urgent visual protection is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Anticoagulation after excluding contraindications and Clear explanation and referral for psychological therapy are less appropriate because they would require different localisation, timing or test findings; Urgent reperfusion assessment with thrombolysis or thrombectomy pathway would fit a different syndrome. Clinical pearl: TIA causes sudden negative symptoms rather than spreading positive phenomena.

Reference: NICE CG150; BASH headache guidance; BNF