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Migraine — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareMigraineUSMLE Step 3

A 39-year-old has eight disabling migraine days monthly and prefers prevention. She has normal blood pressure, no pregnancy plans, and no contraindication to available therapies. She asks whether a calcitonin gene-related peptide–targeting preventive must be withheld until two older drug classes fail. Which response is most accurate?

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Correct answer: E — Select a CGRP-targeting preventive during initial preventive-therapy planning

The best answer is “Select a CGRP-targeting preventive during initial preventive-therapy planning”. The American Headache Society position statement considers CGRP-targeting therapies a first-line migraine-prevention option without requiring prior failure of nonspecific preventive classes. Selection remains individualized by access, preference, comorbidity, and adverse effects. Conventional oral preventives remain reasonable alternatives, but previous failure is no longer an eligibility prerequisite.

Reference: American Headache Society Position Statement: CGRP-Targeting Therapies for Migraine Prevention: https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14692