A 44-year-old woman presents with a bilateral throbbing headache and nausea that was preceded by vision changes of flashing lights and blind spots. Her past medical history is significant for poorly controlled hypertension. Currently, her blood pressure is 182/100 and neurological examination is normal. CT scanning reveals no intracranial pathology. Which of the following is the most appropriate headache treatment at this time?A. High flow oxygen
B. Ibuprofen
C. Sumatriptan alone
D. Sumatriptan plus ergotamine

High flow O2 is best. It is used with those persons who present with severe cluster headache or migraine; the triptan is contraindicated by her B.P., Ibuprofen would not be very useful with presentation of aura and bilateral nature of her headache; ergotamine is surely contraindicated given her history.

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