Adolescent female with unilateral headache around menses; naproxen ineffective; abortive therapy?

Adolescent female with unilateral headache around menses; naproxen ineffective; abortive therapy?

• A. Add acetaminophen and ondansetron to naproxen.
• B. Sumatriptan nasal spray at onset.
• C. Prophylactic therapy with beta-blocker or anticonvulsant.
• D. Refer to pediatric neurologist for neuroimaging.

Answer: (B)

When a teen presents with a migraine that recurs around menses, the goal is to abort the attack quickly with a targeted acute therapy. Sumatriptan given as a nasal spray at the onset of symptoms fits this need well. It acts on serotonin receptors to constrain the trigeminovascular system, leading to rapid relief of migraine pain, making it a preferred abortive option when NSAIDs like naproxen aren’t effective. The nasal form is particularly convenient if nausea or vomiting is present, and it’s approved for adolescents, which supports its use in this setting. Preventive therapy with beta-blockers or anticonvulsants is intended to reduce attack frequency over time, not stop a current episode. Neuroimaging isn’t routinely indicated for typical episodic migraine without red flags. While adding acetaminophen and ondansetron to naproxen might help with symptoms, it doesn’t address the underlying migraine process as effectively as a triptan does for abortive relief.

When a teen presents with a migraine that recurs around menses, the goal is to abort the attack quickly with a targeted acute therapy. Sumatriptan given as a nasal spray at the onset of symptoms fits this need well. It acts on serotonin receptors to constrain the trigeminovascular system, leading to rapid relief of migraine pain, making it a preferred abortive option when NSAIDs like naproxen aren’t effective. The nasal form is particularly convenient if nausea or vomiting is present, and it’s approved for adolescents, which supports its use in this setting.

Preventive therapy with beta-blockers or anticonvulsants is intended to reduce attack frequency over time, not stop a current episode. Neuroimaging isn’t routinely indicated for typical episodic migraine without red flags. While adding acetaminophen and ondansetron to naproxen might help with symptoms, it doesn’t address the underlying migraine process as effectively as a triptan does for abortive relief.