Step 3 UWSA Practice Exam

Migraine prevention uses drugs that dampen neural excitability and modulate pain pathways, reducing how often attacks occur. Among options other than beta-blockers, tricyclic antidepressants are a well-established choice. Low-dose TCAs, such as amitriptyline, can lessen migraine frequency and often help with comorbid insomnia or tension-type features that can trigger headaches. The antidepressant effects are pluses here, but the benefit in migraine comes from how TCAs modulate central pain pathways and stabilize mood and sleep, which can lower attack susceptibility. Practical use involves starting at a low dose at night and titrating slowly, with attention to anticholinergic side effects (dry mouth, constipation), sedation, weight gain, and potential cardiac conduction issues in at-risk patients. While antiepileptics like topiramate or valproate are also used for migraine prophylaxis, the classic choice among the given options beyond beta-blockers is the TCA class due to its proven preventive benefit and broad applicability. SSRIs are not reliably effective for migraine prevention, and beta-agonists are not used for this purpose.