A 30 years-old female presents with headache and transient obscurations of her vision. On examination, no focal neurological deficit was seen. Which one of the following would you sta her on?
**Core Concept**
Migraine is a common neurological disorder characterized by recurrent episodes of headache, often accompanied by sensory and visual disturbances. The pathophysiology of migraine involves the activation of trigeminal nerve terminals, leading to the release of vasoactive peptides and neurotransmitters.
**Why the Correct Answer is Right**
The patient's symptoms of headache and transient visual obscurations, without focal neurological deficits, are consistent with a diagnosis of migraine. The first-line treatment for migraine is a triptan, which works by selectively binding to serotonin receptors on the presynaptic terminals of the trigeminal nerve, inhibiting the release of vasoactive peptides and neurotransmitters. This leads to vasoconstriction of the intracranial blood vessels and relief of migraine symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because antiepileptic medications like carbamazepine are used to treat seizures, not migraines.
**Option C:** This option is incorrect because beta-blockers like propranolol are used to prevent migraine attacks, but not to treat acute migraine attacks.
**Option D:** This option is incorrect because dopamine antagonists like metoclopramide are used to treat nausea and vomiting associated with migraine, but not to treat the headache itself.
**Clinical Pearl / High-Yield Fact**
Triptans are contraindicated in patients with a history of coronary artery disease or vasospastic conditions, as they can cause coronary artery vasoconstriction and exacerbate these conditions.
**Correct Answer:** C. Propranolol