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Migraine prevention — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareMigraine preventionUSMLE Step 3

A 34-year-old woman has unilateral throbbing headaches with photophobia and nausea 8 days per month. Sumatriptan helps, but she misses work twice monthly. Neurologic examination is normal. She is not pregnant and has no asthma or depression. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: A — Start preventive migraine therapy with propranolol

Frequent disabling migraine warrants preventive therapy; beta blockers are standard options when not contraindicated.

Reference: American Headache Society migraine prevention guidance: https://americanheadachesociety.org/