A 40-year-old woman with PMH of fibroids presents to the primary care clinic with headaches that have been occurring
A 40-year-old woman with PMH of fibroids presents to the primary care clinic with headaches that have been occurring over the past several years. She states that the headaches occur in bunches. With these headaches, she will have several episodes lasting an hour each time that occur for a few straight weeks followed by long periods of no symptoms. She feels tremendous sharp pain behind her right eye during the attacks and sometimes has nausea/vomiting with the headaches as well as eye pain, excess tearing, and runny nose. She denies sensitivity to noise or light and auras. She also denies trauma or any neurological symptoms. She eats a normal diet. Patient denies any other symptoms such as weight loss, fever, or chills. The patient’s temperature = 98.5 degrees F, HR = 80, RR = 16, and BP = 130/90. Physical examination is significant for right sided eyelid edema, lacrimation, and conjunctival injection. Which of the following is the next best step in management?A. Sumatriptan and dihydroergotamineB. Sumatriptan and oxygen therapyC. Ibuprofen
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