Susan is a 32-year-old white woman who presents to the clinic with recurrent migraine. She reports that she has a moderate to severe migraine once a week, on average. She uses SC Imitrex (sumatriptan), and most of the time the headache resolves with one dose. She was told to return for a checkup if she had to use the Imitrex more than two or three times a month. Susan is married and has four children. She experienced her first migraine at age 18 and has no other health problems. She was started on Imitrex and has had good results. She is otherwise healthy. She reports a 2 to 4 cup a day intake of coffee; usually, one of those "cups" is a double latte. She occasionally uses. Excedrin Migraine for relief of mild headache—she thinks only once or twice a week. She has never been hospitalized overnight for her migraines but has gone to the emergency room for "pain medicine" before she was started on Imitrex. A. What is your initial management plan for Susan?
B. What are important patient education points to make when advising Susan?
C. How would you define failure of an intervention (i. e. a medication)? When would you change your plan? What would your next steps look like if your initial management plan failed?