267 ) A 32 year old woman is evaluated in your office for increasing headaches over the past few months. She has a 5 year history of intermittent headaches. The headaches are throbbing in nature and are localized to frontal area. They are often accompanied by nausea and vomiting. Her episodes are usually preceded by irritability and food craving. She usually takes ibuprofen at the onset of headache which seem to relieve her pain. She recently broke up with her partner and has been under severe emotional stress since then. Lately, her headaches have become more frequent occurring about 4 to 5 times per month. The episodes interfere with her quality of life. She denies any headache at this time. Physical examination including neurological and ophthalmoscopic exam is normal. Her last menstrual period was 16 weeks ago and a urine pregnancy test returns positive. Which of the following strategies is most appropriate for this patient?
A) Biofeedback
B) Lumbar puncture
C) Start Propranolol
D) Start Sumatriptan
E) Start Valproic acid
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