“My migraine headaches will not go away.”
Please read the following Case Study and answer the questions posed.
Complaint
“My migraine headaches will not go away.”
History
A 32-year-old female presents to the clinic with recurrent migraine. She reports that she has a moderate to severe migraine once a week, on average. She uses SC Imitrex (sumatriptan), and most of the time the headache resolves with one dose. She was told to return for a checkup if she had to use the Imitrex more than two or three times a month. Susan is married and has four children. She experienced her first migraine at age 18 andhas no other health problems. She was started on Imitrex and has had good results. She is otherwise healthy. She reports a two to four cup a day intake of coffee; usually, one of those “cups” is a double latte. She occasionally uses Excedrin Migraine for relief of mild headache— she thinks only once or twice a week. She has never been hospitalized overnight for her migraines but has gone to the emergency room for “pain medicine” before she was started on Imitrex.
Assessment
Susan is afebrile, vital signs are all within normal limits (WNL), and her weight is 135 pounds (body mass index [BMI] is 24), which is stable. The physical examination is completely WNL.
Her neurological examination is unremarkable.
Questions
- What would be the initial management plan?
- What would be the plan when the patient returns with her headache diary?
- What medications can prevent migraines?
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