A patient who experiences migraines characterized by unilateral motor and sensory symptoms tells the primary care NP that despite abortive therapy with a triptan, the frequency of episodes has increased to three or four times each month
The NP should: a. add a selective serotonin reuptake inhibitor (SSRI) antidepressant.
b. change to dihydroergotamine hydrochloride.
c. prescribe a ?-blocker such as propranolol.
d. prescribe an anticonvulsant such as topiramate.
D
Topiramate is useful for migraine prophylaxis. SSRI antidepressants are considered second-line treatment for prophylaxis and are less effective than tricyclic antidepressants. Ergotamines are not used as prophylaxis. ?-Blockers are commonly used but may aggravate neurologic symptoms associated with hemiplegic or basilar migraine, which is what this patient has.
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