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Twenty-Seven-Year-Old Woman With Uncontrolled Migraines

A 27-year-old woman presents to you with a history of migraines since she was 12. Her mother and sister also had migraines. She currently has about six migraines each month and reports that she also experiences daily headaches.

When the patient experiences migraines, they usually last about one day and are moderate to severe in nature with nausea. Stress, menstruation and weather changes are triggers. She currently takes four tablets of an extra-strength over-the-counter medication for her daily headaches.

The patient has previously been prescribed hydrocodone for her migraines. She states that it only reduces the pain by about 25 percent.

What do you recommend as a pain management treatment plan? What thought processes are you using to back up your suggestion?