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Clinical Crossroads
March 25, 1998

A 27-Year-Old Woman With Migraine Headaches, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 1998;279(12):954. doi:10.1001/jama.279.12.954

At Medicine Grand Rounds in April 1997, Dr K. M. A. Welch discussed the options for a 27-year-old woman with migraine headaches that had occurred up to 5 times per month.1 At that time, use of β-blockers had decreased the frequency of her migraines to 1 per month just prior to her menses.

Dr Welch described the common triggers of migraine attacks as well as their diagnosis, epidemiology, and pathogenesis. He provided a detailed approach to the management of migraines, including both abortive and preventive use of different medications. Dr Welch suggested that Mrs D, the patient, might get better relief of her migraines by following her sumatriptan succinate injection with an oral form of the drug, and that she might also benefit from prophylactic use of a nonsteroidal anti-inflammatory agent prior to the onset of her menses. We asked the patient and her primary physician to comment on the year that has passed.