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A 28-Year-Old Man Comes to the Office for a Health

Question 697
Multiple Choice
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Multiple Choice

A 28-year-old man comes to the office for a health maintenance visit.  He has no history of serious illness but reports periodic headaches over the last several years that often respond to acetaminophen.  Occasionally the headaches are severe enough to necessitate taking a sick day from work.  He cannot recall specific triggers but notes that the headaches are usually unilateral.  The patient does not use tobacco or illicit drugs.  He drinks alcohol socially and 2-3 cups of coffee daily.  He is a software engineer and often works at a computer 10-12 hours a day.  His sister has a history of migraines.  Vital signs are within normal limits.  Physical examination, including neurological examination, is normal. The patient states that the prior headaches were of similar nature and recurred several days in a row before remitting.  Recently, the periods of active headaches have increased in duration with no remission.  Which of the following is the best pharmacotherapy for headache prevention in this patient?


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