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Migraine — CCFP MCQ

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HardChronic disease managementMigraineCCFP

A 31-year-old has recurrent episodic migraine meeting diagnostic criteria. Attacks are unchanged for years, neurological examination is normal and there are no red flags such as thunderclap onset, fever, papilledema, focal deficit or onset after age 50. She requests a CT scan for reassurance. What is the most appropriate response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Explain imaging is unnecessary; optimize migraine care and give red-flag advice

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

B is correct. Canadian Headache Society Choosing Wisely guidance advises against neuroimaging in episodic migraine with a normal examination and no secondary-headache red flags; education and optimized care are more useful. C and D expose the patient to low-yield investigation and potential incidental findings. E is not first-line and can contribute to medication-overuse headache. A risks medication overuse and bypasses a proper treatment review. Give clear advice to seek urgent reassessment if the pattern or examination changes.

Reference: Choosing Wisely Canada / Canadian Headache Society: Headache recommendations: https://choosingwiselycanada.org/recommendation/headache/