This is a 35 y/o woman who presents to the office with a 7 year history of headaches that started out perimenstrually but over the last 2 years, she notes that they have become more frequent. She is now having headaches about twice per week that are unilateral (but can change sides), associated with light and noise sensitivity. The bad headaches are associated with nausea. When she has a headache, she has trouble functioning at work and home. She has been taking Excedrin migraine but this was just taken off the market due to production issues. Her neurologic exam including funduscopic exam was normal. She is not overweight but sleeps poorly.
1. What is her diagnosis?
2. Does she need imaging?
3. What should she use to acutely treat her headaches?
4. Should she be on a daily preventative medication? If so, what?