25 y/o woman with hx of endometriosis, has had 2 year history of migraines, however, they bother only once or twice a month. Only one of these attacks a month makes her really disabled. She has been started on propranolol 6 months ago and has been headache free for about three months. She says she recently started oral contraceptive pills 3 months ago and her headaches have been out of control. She is getting about 3 to 4 episodes of migraines per month now but no aura. Physical exam is normal. What is the most appropriate next step in management ?
A) Discontinue Oral Contraceptive pills
B) Switch to OCPills with low dose estrogen.
C) Start prophylaxis with Topiramate
D) Switch to OC Pills with high dose Estrogen
E) Obtain MRI Brain with gadolinium
Copy Rights : USMLEGalaxy, LLC