A Case for Sumatriptan

image credits: Arty Smokes

S.M., 23 y.o., male from Manila. On consult at a neurologic clinic, patient presents with generalized headache with a pain score of 7/10.

Onset of pain was 4 days prior to consult, probably provoked by stress-induced ward works and plenary lectures.

Pain progressed from mild to moderate 2-3 days prior to consult, which the patient decided to take self-medication of paracetamol and ibuprofen, but was not alleviated.

A day prior to neurologic consult, patient visited a family medicine clinic, where the consultant gave a medical impression of probable migraine, and advised to take naproxen and diclofenac under observation. Upon follow-up, patient reports that the NSAIDs did not palliate the pain significantly. He was then referred to a headache / neurologic clinic.

On day of neurologic consult, patient describes the pain as throbbing and generalized.

Patient was able to locate the pain post-sleeping on the left side of the head radiating from the nape towards the left forehead and temporalis area. The patient also describes fatigue and pain that is almost compressed on both periorbitals.

Patient reports nausea, but no vomiting, fever, flu, colds, cough or pain in the sinus area.

Based on this short pertinent history and brief physical examination, the neurologist diagnosed the case as migraine, prescribed the continued use of naproxen to see if it would work, and provided a written prescription for sumatriptan in case it did not.

Because of that, the patient felt a lot better, knowing that someone has finally agreed with the diagnosis he was anxious about, and that he has a doctor's prescription of sumatriptan in his hands, which works in 75% of all cases of migraine attacks according to literature.

Author's note: Thank you, Dr. Paul Matthew Pasco of the Philippine General Hospital. Dr. Pasco is a young, talented neurologist and is well recommended by his patients.

Disclaimer: The headache case is only a retelling by the patient and may not necessarily indicate the exact neurologic finding.