Neurology: migraine with aura and contraception: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Neurology: migraine with aura and contraception

Sample item

A 29-year-old woman has migraine with visual aura (zigzag lines for 20 minutes before the headache) and is taking a combined oral contraceptive pill. What is the most appropriate advice?

AContinue the combined pill and add daily aspirinBSwitch to a non-oestrogen method such as a progestogen-only pill or copper intrauterine deviceCContinue the combined pill and add propranololDChange to a higher-dose oestrogen pill

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Switch to a non-oestrogen method such as a progestogen-only pill or copper intrauterine device

Migraine with aura is an independent risk factor for ischaemic stroke, and oestrogen-containing contraceptives raise that risk further, so they are contraindicated. Progestogen-only methods and non-hormonal methods are safe alternatives. Smoking compounds the risk.

Option by option

A. Continue the combined pill and add daily aspirin
Aspirin does not neutralise the prothrombotic effect of oestrogen and is not an accepted risk-reduction strategy here.
B. Switch to a non-oestrogen method such as a progestogen-only pill or copper intrauterine device (correct)
Correct. Avoiding oestrogen removes an avoidable stroke risk.
C. Continue the combined pill and add propranolol
A beta-blocker may reduce migraine frequency but does not remove the stroke risk of oestrogen.
D. Change to a higher-dose oestrogen pill
A higher oestrogen dose would increase the thrombotic and stroke risk.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Switch to a non-oestrogen method such as a progestogen-only pill or copper intrauterine device. Migraine with aura is an independent risk factor for ischaemic stroke, and oestrogen-containing contraceptives raise that risk further, so they are contraindicated.

Why is "Continue the combined pill and add daily aspirin" not the answer?

Aspirin does not neutralise the prothrombotic effect of oestrogen and is not an accepted risk-reduction strategy here.

Why is "Continue the combined pill and add propranolol" not the answer?

A beta-blocker may reduce migraine frequency but does not remove the stroke risk of oestrogen.

Why is "Change to a higher-dose oestrogen pill" not the answer?

A higher oestrogen dose would increase the thrombotic and stroke risk.

What concept does this question test?

It tests Neurology: migraine with aura and contraception in General Medicine. Progestogen-only methods and non-hormonal methods are safe alternatives. Smoking compounds the risk.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: migraine with aura and contraception?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.