A 29 year old man presents to your office with 3 months of recurrent headaches. The headache is a unilateral, throbbing headache with associated nausea which lasts 1- 3 days. The patient has been taking ibuprofen and acetaminophen regularly every day for the past 2 months. The pain is now daily. There has been no morning vomiting, vision changes or focal neurological symptoms.
Be careful not to exceed NSAID/Tylenol use >15 days a month for fear of medication overuse headache. In this patient case, it appears as if medication overuse headache is likely, so immediate cessation of those medications is warranted. Triptans are the next step in abortive pharmacological therapy. In patients having 3 or more migraines a month, consider prophylaxis with beta blockers, TCAS or anticonvulsants.
Card: Headache MC 006
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