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Propranolol
14%
5/37
Amitriptyline
3%
1/37
Ergonovine
24%
9/37
Chlorpromazine
51%
19/37
Calcium channel blockers
5%
2/37
Select Answer to see Preferred Response
This patient is experiencing a migraine headache with nausea and vomiting. Antiemetics (such as chlorpromazine) are appropriate acute treatment in this setting. Migraine headache typically presents with throbbing, unilateral pain. Patients often also have nausea or vomiting, and may have photophobia. About 15% of patients also experience aura. Management of migraine headaches often begins with placing the patient in a quiet, dark environment. Acute migraine may be treated with sumatriptan, ergots, NSAIDS, or antiemetics (including chlorpromazine). In children, first line treatment is acetaminophen or NSAIDS. Prophylaxis against migraine headaches may include amitriptyline, propranolol, ergonovine, or calcium blockers. Gilmore and Michael further discuss the treatment of acute migraine headache. Treatment modalities are broken down into abortive and preventative, and are also prioritized by the severity of the migraine. For mild-to-moderate migraines, non-prescription NSAIDs or combination pills containing acetaminophen, aspirin, and caffeine are frequently sufficient. For migraines that are more severe (moderate-to-severe pain), triptans are often considered first line. Triptans are also first line for mild-to-moderate migraines that to not respond to the mild analgesics discussed above. Triptans should be avoided in patients with vascular disease or uncontrolled hypertension. IV antiemetics are effective treatment in the emergency department. Carod-Artal discusses treatment of chronic migraines. For chronic migraines, preventative regimens may include one of several antiepileptic drugs. Common choices are topiramate or sodium valproate. Additionally, amitriptyline has been effectively used. Compliance should be assessed, as studies have demonstrated that many chronic migraine patients fail to take their preventative medication correctly. Incorrect answers: Answers 1-3, 5: All of the incorrect choices may be used as prophylactic medications, but are not recommended for treatment of nausea and vomiting.
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