Nora, a 35-year-old woman, has a seven-year history of low episodic migraines. She does not experience auras during these episodes which have a duration of between four and five hours. Previously, she experienced migraines between three and seven times per month.
Her previous pain management of 50 mg of oral sumatriptan worked well until she underwent a hysterectomy. This surgery followed a two-year-long period of severe menorrhagia due to numerous uterine fibroids.
Nora presents today with a sharp increase of migraine days with up to 15 monthly. Additionally, these episodes are now lasting up to eight hours a day with the sumatriptan no longer being effective.
How would you classify Nora's migraines at this point? What course of pain management would you offer her?