migraine headache

Case
Study Week #6
NU 702
Advanced
Pharmacotherapeutics
Husson
University

Complaint:
My migraine headaches will not go away.

History:
Susan is a 32-year-old white woman who 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 2 to 4 cup a day intake of coffee; usually,
one of those cups is a double latte. She occasionally uses Excedrin Migraine
for relief of mild headacheshe 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 is135 pounds (body mass index [BMI] is 24), which is stable. The
physical examination is completely WNL. Her neurological examination is
unremarkable.

What is your initial management plan for Susan?

What are important patient education points to
make when advising Susan?

How would you define failure of an intervention
(i.e. a medication)? When would you change your plan? What would your next
steps look like if your initial management plan failed?

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