A 34-year-old woman complains of headaches that interfere with work. Her first headache episode, approximately 6 years
earlier, was relatively mild. Initially, she experienced attacks only once every 3 to 4 months and managed them effectively
with over-the-counter (OTC) agents. However, in the last 6 months the attacks have become more frequent--they occur at
least twice a month--and are so severe that she misses work.
The patient takes acetaminophen, ibuprofen, or the combination of acetaminophen, aspirin, and caffeine for her
headaches. She has increased her use of OTC agents to at least 2 or 3 days a week in anticipation of attacks.
Results of physical and other examinations are otherwise normal. A diagnosis of migraine without aura, according
to International Headache Society criteria, is made.