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Original Question

A 40-year-old woman with a past medical history of hypertension and uterine fibroids presents to the primary care clinic reporting headaches that have been occurring over the past several years. She is currently pain-free, but her headaches are disabling when they occur over periods of several weeks, followed by long periods of remission. The headaches generally last about an hour. They are characterized by retro-orbital pain on the right, nausea and vomiting, excess tearing, and rhinorrhea. She denies auras, photophobia, phonophobia, neurologic deficit, or trauma. She eats a normal diet and denies weight loss. The patient’s temperature is 98.5 degrees Fahrenheit, HR is 80, RR is 16, and BP is 130/90. A physical exam reveals slight tenderness to palpation around the left temporal region. Neurologic examination reveals no abnormalities. Which of the following is the best prophylactic medication used to prevent this type of headache? • A. Sumatriptan (Imitrex) • B. Amitriptyline (Elavil) • C. Ibuprofen (Motrin, Advil) • D. Verapamil (Verelan) Image transcription text A 40-year-old woman with a past medical history of hypertension and uterine fibroids presents to the primary care clinic reporting headaches that have b… Show more

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