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Migraine prophylaxis — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareMigraine prophylaxisUSMLE Step 3

A 31-year-old woman returns for migraine follow-up. She has unilateral throbbing headaches with photophobia 8 days per month despite avoiding triggers and using sumatriptan. Neurologic examination is normal. She is not pregnant and uses reliable contraception. Blood pressure is 118/70 mm Hg. Which of the following would you recommend at the follow-up visit?

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

Reveal the answer and explanation

Correct answer: E — Start topiramate preventive therapy

Frequent migraines causing functional impairment warrant preventive therapy; topiramate is an evidence-based option when not contraindicated.

Reference: American Headache Society Migraine Prevention Guidance