Primary headaches (tension, migraine, and cluster) Quiz: Ace Your Exams
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A 48-year-old man presents to the primary care office for evaluation of frequent, recurrent headaches. For the past year, he has experienced recurrent episodes of mild, bilateral, squeezing head pain in a band-like distribution. He reports the symptoms are often triggered by stress, dehydration, and sleep deprivation, and they occur 2-3 times per week. He has no associated light or sound sensitivity, nausea, vomiting, or focal neurological deficits. Past medical history includes gastroesophageal reflux for which he takes omeprazole. He uses acetaminophen for the treatment of headaches, but it has lost efficacy over time. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 128/85 mmHg. Examination reveals normal strength, reflexes, sensation, and coordination, with a normal fundoscopic examination. Mental status exam, cranial nerve exam, and neck exam are all within normal limits. In addition to recommending lifestyle modifications, which of the following should be prescribed to prevent future headaches?
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