19th June 2023

A 46-year-old female was diagnosed as having migraine with sensory aura by her neurologist a year ago

A 46-year-old female was diagnosed as having migraine with sensory aura by her neurologist a year ago. She was started on amitriptyline, of which she currently takes 75mg a day. She has been headache-free since being established on amitriptyline; however, she has now presented to A&E with a severe headache following a small family get-together where she admits to drinking more alcohol than usual. She also reports some pins and needles of the left side of the face and the left arm, which started at the same time as the headache, about an hour ago. She reports that this is similar to her previous migraines. On examination, sensation is reduced on the left arm compared to the right, but there are no specific sensory levels. Her motor power on all limbs is 5/5. The rest of the neurology examination is unremarkable. After 30 mins, the numbness on both face and arm has resolved. She is still complaining of a headache which is 8/10 severity and is requesting some analgesia.

Of the following options, which is the most appropriate management of her current pain?