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Sixty-Year-Old Man With Debilitating Daily Migraines

A 60-year-old male with a 20 year history of daily migraines comes to you for new options for pain management. Due to the debilitating effects of the migraines, as well as his poor neurological health and the management of his medication schedule, the patient is no longer able to maintain employment.

He has taken a number of medications with various effects including methadone and candesartan with provided him with only moderate pain relief. Morphine proved to be sedating while trazadone, methylphenidate and naratriptan made him drowsy. The latter medication also caused him confusion.

What treatment options do you recommend for this patient and why? Do you foresee a time when he can become employable once again and have the ability to enjoy a higher quality of life than he has right now?