Question

A 35-year-old woman is diagnosed with migraine and has a family history of coronary artery disease. She has been previously treated with sumatriptan. What is the drug of choice for migraine prophylaxis?

• A. Propranolol
• B. Topiramate
• C. Ergotamine
• D. Naratriptan

Hint:

Migraine acute attack = triptans; migraine prophylaxis = propranolol, topiramate, valproate, etc.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
The question asks for the preferred long-term preventive treatment (prophylaxis) for a young woman with migraines, while also noting a relevant family history.
Step 2: Detailed Explanation:

Prophylaxis Criteria: Prophylaxis is indicated if migraine attacks are frequent (e.g., more than 2-3 times per month), severe, or significantly interfere with daily life.

Propranolol: Non-selective beta-blockers like Propranolol are considered first-line agents for migraine prophylaxis. They are thought to work by stabilizing cerebral blood vessels or modulating cortical excitability.

Clinical Advantage: Propranolol is well-tolerated in most young patients and is particularly useful if the patient also has co-existing hypertension or anxiety. Its safety profile is well-established.

Why others are incorrect: Topiramate (Option B) is also a first-line prophylactic agent (an anti-epileptic). However, Propranolol is often favored as the initial choice unless contraindicated (e.g., asthma). Ergotamine (Option C) and Triptans (Option D) are used for acute abortive treatment of a migraine attack, not for daily prophylaxis.

Family History Context: While the patient has a family history of CAD, she is only 35. If she \textit{herself} had active ischemic heart disease, triptans (which cause vasoconstriction) would be contraindicated, but beta-blockers like Propranolol would actually be beneficial.

Step 3: Final Answer:
Propranolol remains a gold-standard first-line pharmacological choice for the prophylaxis of migraine.