You are seeing a 33-year-old patient who presents with several weeks of gradually worsening headaches that he describes as severe and upsetting.
You are seeing a 33-year-old patient who presents with several weeks of gradually worsening headaches that he describes as severe and upsetting. They tend to occur three to four times per week and get worse as the day goes on. He describes them as feeling “like a vice squeezing my whole head.” Ibuprofen has partially helped the pain. Unfortunately, he never has ibuprofen with him at work where the headaches are more common, because his new boss does not allow medications to be kept at work without a doctor’s note. He reports no nausea, vomiting, lacrimosis, or photophobia. He is not awakened from sleep by the headaches. He appears mildly distressed, and his vital signs are normal. Examination of his head and neck, fundic discs, and cranial nerves is grossly normal. What is the most appropriate step in management of his headaches? A. Instruct the patient to discontinue ibuprofen, as it is causing medication overuse headaches. B. Order a CT scan of the patient’s head to rule out intracranial pathology. C. Prescribe ibuprofen to be taken as needed and provide a note for work. D. Prescribe propranolol to be taken as migraine prophylaxis. E. Prescribe sumatriptan as needed and provide
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