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Migraine preventive therapy selection — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareMigraine preventive therapy selectionUSMLE Step 3

A 39-year-old man with migraine has 8 headache days per month. Headaches are unilateral, throbbing, associated with photophobia, and disabling. He uses sumatriptan with relief but wants prevention. He has asthma and depression treated with fluoxetine. Blood pressure is 118/72 mm Hg. Which of the following is the most appropriate next step in management?

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Correct answer: A — Topiramate preventive therapy

Frequent disabling migraine warrants preventive therapy. Topiramate is an appropriate option; beta-blockers can worsen asthma, and opioids or butalbital increase medication-overuse headache risk.

Reference: American Headache Society migraine prevention guidance