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Medication-overuse headache — SCE Neurology MCQ

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ModerateHeadacheMedication-overuse headacheSCE Neurology

A 38-year-old woman with migraine now has near-daily headaches. She takes co-codamol on 22 days each month and sumatriptan on 12 days each month. Neurological examination and fundoscopy are normal. MRI requested privately is normal. What is the most appropriate management?

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Correct answer: D — Withdraw overused acute medicines with support

Withdraw overused acute medicines with support is the best answer. Frequent opioid and triptan use with daily headache is medication-overuse headache, managed by withdrawal with education and support. Increasing opioids perpetuates the disorder; steroids are not routine long-term treatment; angiography and LP are not indicated without red flags. Clinical pearl: Medication-overuse headache is treated by reducing acute-drug exposure, not by escalating it.

Reference: NICE CG150; BASH headache guidance