Woman With "Stress Headaches"
A 30-year-old woman presents to your clinic with what she terms as "stress headaches." She first had onset of these headaches when she was in her late teens. Over the past year, however, they've been worse.
Typically, the patient feels a tight sensation high in her neck area. The headaches happen once or twice a week, last about 13 hours each time and occur bilaterally. She experiences some sensitivity to noise and light. The patient describes the pain as being moderate to severe and states that she is unable to work because of her headaches sometimes.
What is your diagnosis for this patient? What medication plan would you recommend that she start with and why?