Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine.
What is the best care for her?
1. Switch her to sumatriptan (Imitrex) to treat her migraines.
2. Assess how often she is using Fiorinal and refill her medication.
3. Switch her to a beta blocker such as propranolol to prevent her migraine.
4. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines.
Question 2
Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be:
1. Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use.
2. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.
3. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).
4. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.
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