Question

case study topic

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 and
has 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.



1. What would be the initial management plan?

2. What would be the plan when the patient returns with her headache diary?

3. What medications can prevent migraines? List 3 medications.

4. Identify a current guideline or an evidence-based article regarding the treatment of migraines.

Answer 1

Migraines

It is severe form of headache that varies in intensity often associated with nausea, sensitive to light and sound.

1. What would be the initial management plan?

-nonsteroidal anti-inflammatory drugs and acetaminophen can be used for initial treatment for mild to moderate migraines

-to treat moderate to severe migraines, triptans are the first line treatment.

2. What would be the plan when the patient returns with her headache diary?

- it is helpful for doctors to make firm diagnosis.

- helps to identify warning signs and triggering factors

medicines such as dihydroergotamine and antiemetics are used for second- or third-line therapy for selected patients or for those with refractory migraine.

4. Identify a current guideline or an evidence-based article regarding the treatment of migraines.

"The journal of headache and pain" is published in september 2020, discuss an evidence based article on migraine treatments.