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Migraine prevention with CGRP-pathway therapy — SCE Neurology MCQ

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HardHeadacheMigraine prevention with CGRP-pathway therapySCE Neurology

A 41-year-old woman has 12 migraine days monthly despite adequate trials of propranolol, topiramate and amitriptyline. She has normal examination and no medication overuse after withdrawal support. She prefers an oral preventive if available and has no major hepatic disease. What is the most appropriate management?

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Correct answer: B — Consider atogepant under local criteria

Consider atogepant under local criteria is the best answer. Atogepant is a CGRP receptor antagonist option for migraine prevention after failure of several preventives when criteria are met. Opioids risk medication overuse; long-term steroids are not migraine prevention; thrombolysis is irrelevant; carbamazepine is not standard migraine prophylaxis. Clinical pearl: Modern migraine care increasingly includes CGRP-pathway options after conventional preventive failure.

Reference: NICE TA973; NICE CG150