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Migraine — DCH MCQ

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ModerateChronic conditionsMigraineDCH

A 13-year-old girl has had headaches twice a month for 6 months. Each episode lasts 6–12 hours and consists of bilateral throbbing pain that is worsened by routine activity and makes her lie down. She experiences nausea and photophobia during the attacks. She has no visual, sensory or speech symptoms, and uses simple analgesia only during these episodes. Her blood pressure, fundoscopy and neurological examination are normal. What is the most likely diagnosis?

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Correct answer: D — Migraine without aura

The diagnosis is migraine without aura. The attacks last within the 1–72-hour range recognised for migraine in 12–17-year-olds and feature throbbing pain, worsening with routine activity, nausea and photophobia. The absence of reversible visual, sensory or speech symptoms indicates migraine without aura. Tension-type headache is usually pressing or tightening, is not aggravated by routine activity and lacks nausea or marked sensory sensitivity. Cluster headache causes short, severe unilateral attacks with ipsilateral autonomic features and restlessness. Medication-overuse headache requires frequent medication exposure and a much higher headache burden. Raised intracranial pressure is unlikely with stable episodic attacks and normal fundoscopy and neurological examination.

Reference: National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (CG150), recommendation 1.2.1 and Table 1. Updated 2025. https://www.nice.org.uk/guidance/cg150/chapter/recommendations