Migraine — CCFP MCQ

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EasyChronic disease managementMigraineCCFP

A 36-year-old man has recurrent unilateral throbbing headaches lasting 8 to 24 hours with nausea, photophobia and worsening with activity. Neurological examination is normal. He has 3 attacks monthly and no red flags. What is the most likely diagnosis?

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Correct answer: A — Migraine without aura

The patient presents with classic features of migraine without aura. His headaches satisfy IHS diagnostic criteria: recurrent attacks, 4–72 hour duration (his 8–24 hours fits), ≥2 pain characteristics (unilateral, pulsating, aggravated by activity), and ≥1 associated symptom (both nausea and photophobia present). Cluster headaches are briefer (15–180 min), unilateral with autonomic features (lacrimation, rhinorrhea), not mentioned here. Giant cell arteritis occurs in older adults (>50 years) with systemic symptoms and elevated inflammatory markers. Tension-type headache is bilateral, pressing (not throbbing), lacks photophobia and nausea. Subarachnoid haemorrhage is an acute secondary condition, not a benign recurrent disorder. Migraine without aura is the only defensible diagnosis.

Reference: College of Family Physicians of Canada. Guideline for primary care management of headache in adults. Canadian Family Physician 2015;61(8):670–679. https://www.cfp.ca/content/61/8/670.long