1. Jung, Sharon

Migraine headaches are common and among the most disabling nonfatal conditions of humankind. They are frequently misdiagnosed, which may lead to undertreatment. Patients often self-diagnose and self-medicate, resulting in inadequate treatment. Consequently, patients may take additional doses, trying to gain relief with inappropriate medications. Rebound can ensue. With adequate treatment, a patient's condition and quality of life may improve considerably. Patient education is extremely important to help patients identify appropriate self-care measures, such as identification of triggering events and coping with the chronic nature of their condition. This case study presents a patient who began experiencing migraines following a neck injury. His headaches became more frequent, and ergotamine and caffeine (Cafergot(R)) suppositories were prescribed. When he presented, he was experiencing daily headaches and using daily ergotamine and caffeine suppositories. He was using the emergency department (ED) frequently because of severe headaches. Cervical spasm was recognized as his trigger, and the ergotamine and caffeine suppositories were discontinued. After 3 days of severe headaches, his rebound ceased. He reverted back to episodic migraines, which he treated with zolmitriptan (Zomig(R)) nasal spray, which was effective. His cervical spasm was treated with botulinum toxin type A (Botox(R)), with excellent results. He has maintained reasonable headache control for 2 years.