What lifestyle modifications and non-pharmacological treatment options would you recommend?
She reports that she “wakes up with the headaches and they only occur behind one eye.” The headaches usually peak around lunch time, and are accompanied by nausea, fatigue and irritability. They occur at least once a week, and she usually has to skip class or call in to work because she is so nauseous and sensitive to light and noise. She takes Ibuprofen for the headaches but it “doesn’t really help.” She goes to college full-time and works at a fast-food restaurant to pay the bills. She states that she is constantly stressed and gets about 5 hours of sleep at night. Reports that she does not have time to exercise and usually just grabs fast food to eat. She is sexually active with her boyfriend who she shares an apartment with, and they do not use protection. Denies any medical/surgical history. Her mother and father both take medication for hypertension and her mother is on a daily medication for prevention of migraines. Vital signsHR 72, BP 118/69, T 98, O2 100%, RR 16Height 5ft 2 inWeight 73 kgMedications: Ibuprofen 400 mg occasionally for headaches and menstrual cramps, daily women’s multivitaminQuestions:What is the most likely diagnosis for this patient and why?What lab work or additional history information would you need prior to prescribing medication?What medications might you prescribe and what education would you provide regarding the medication?What lifestyle modifications and non-pharmacological treatment options would you recommend?
