A 38-year-old male patient reports having an increasing number of headaches per month. He has suffered from migraines for over a decade which have been increasing slowly. He has been diagnosed with chronic migraine and suffers from moderate-to-severe migraine with nausea that lasts 12 hours about 8 times a month. In the last 2 years, he has also endured more frequent headaches occurring at least five days a week which are moderate in nature with throbbing and photophobia. Currently he takes a triptan (Imitrex, Zomig, etc.) to manage migraines but also uses over-the-counter simple analgesics or combination pain relievers to help manage his headaches. The patient also has associated neck pain, with tenderness in her neck and shoulder muscles.

Currently, this patient has a BMI of 30, is a regular smoker, drinks coffee daily, and suffers from Irritable Bowel Syndrome (IBS).

What treatment(s) would you recommend for this patient? What factors would you consider when deciding how to treat this patient? What preventive medicines are possible in his situation?

A 38-year-old male patient reports having an increasing number of headaches per month. He has suffered from migraines for over a decade which have been increasing slowly. He has been diagnosed with chronic migraine and suffers from moderate-to-severe migraine with nausea that lasts 12 hours about 8 times a month. In the last 2 years, he has also endured more frequent headaches occurring at least five days a week which are moderate in nature with throbbing and photophobia. Currently he takes a triptan (Imitrex, Zomig, etc.) to manage migraines but also uses over-the-counter simple analgesics or combination pain relievers to help manage his headaches. The patient also has associated neck pain, with tenderness in her neck and shoulder muscles.

Currently, this patient has a BMI of 30, is a regular smoker, drinks coffee daily, and suffers from Irritable Bowel Syndrome (IBS).

What treatment(s) would you recommend for this patient? What factors would you consider when deciding how to treat this patient? What preventive medicines are possible in his situation?

A 38-year-old male patient reports having an increasing number of headaches per month. He has suffered from migraines for over a decade which have been increasing slowly. He has been diagnosed with chronic migraine and suffers from moderate-to-severe migraine with nausea that lasts 12 hours about 8 times a month. In the last 2 years, he has also endured more frequent headaches occurring at least five days a week which are moderate in nature with throbbing and photophobia. Currently he takes a triptan (Imitrex, Zomig, etc.) to manage migraines but also uses over-the-counter simple analgesics or combination pain relievers to help manage his headaches. The patient also has associated neck pain, with tenderness in her neck and shoulder muscles.

Currently, this patient has a BMI of 30, is a regular smoker, drinks coffee daily, and suffers from Irritable Bowel Syndrome (IBS).

What treatment(s) would you recommend for this patient? What factors would you consider when deciding how to treat this patient? What preventive medicines are possible in his situation?