Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be:
1. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers.
2. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress.
3. Prescribe acetaminophen with codeine (Tylenol 3) for her to take at the first onset of her migraine.
4. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.
Question 2
Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month.
Which of the following would be appropriate?
1. Prescribe amitriptyline (Elavil) daily, start at a low dose and increase dosage slowly every 2 weeks until it's effective in eliminating migraines.
2. Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.
3. Prescribe propranolol (Inderal) to be taken daily for at least 3 months.
4. Explain that it is rare for a 9-year-old child to get migraines and she needs an MRI to rule out a brain tumor.
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