CASE STUDY:
Della Ricci, a 39-year-old female client (DOB: 4/1/1985), presents to the Emergency Department (ED) with complaints of frequent migraines with aura. She states one such episode just ended as she arrived at the parking lot of the ED, driven by her husband. She states that typically, the episode starts with bright zigzag lights on one side of her vision, followed by throbbing pain on one side of the head with sensitivity to light. Once the pain happens, the client states she cannot engage in daily activities and must lie down in a dark room, as walking exacerbates the pain. Della states she has had at least seven episodes like this over the past month. Her exam is unremarkable, her vital signs are normal, and she has no symptoms. Della requests medication to take the next time one of these episodes occurs to stop the migraine.
Past Medical History: Intrauterine device (IUD) insertion
Allergies: None
Medications: Multivitamin
Social History: She has never smoked cigarettes and drinks alcohol once or twice a year on special occasions.
Physical Exam:
• Height: 5 feet 8 inches
• Weight: 135 lbs
• Body Mass Index (BMI): 20.5
• Blood Pressure (BP): 116/72
• Heart Rate (HR): 76
• Respiratory Rate (RR): 17
• Oxygen Saturation (O2 Sat): 98% on RA
• Temperature (TEMP): 98.6 oral
An appropriate prescription for Della is:
Name: Della Ricci
Date Of Birth: 4/1/1985
Date Prescribed: Current Date
Rx: sumatriptan (Imitrex) 25 mg
Disp: 30
Sig: Take one tablet by mouth once at the onset of a migraine. If symptoms do not improve or return, a second dose of one tablet by mouth may be taken at least two hours after the first dose.
Refills (O-4): 4
Dispense as Written:
Generic Substitution Permitted:
• Either Dispense as Written or Generic Substitution Permitted should be checked on every written prescription depending on what is best for each client. Refer to the week 1 lesson for criteria.
Rationale: Della is experiencing migraines with aura and requires medication to relieve active migraine symptoms. According to the CPG, first-line medications for migraines with aura include triptans, like sumatriptan. The starting dose is 25 mg at the time of migraine onset, followed by one additional dose at least two hours later if symptoms resolve or return. Oral medications are suitable since the client does not experience nausea during the episodes (Ailani et al., 2021; Luu et al., 2021; Rosenthal & Burchum, 2025). Necessary preventative migraine treatments should also be considered.

Step 1: Assess the client’s case, the applicable clinical practice guideline (CPG), and the prescription information provided.
Step 2: Answer the discussion prompts below with explanation and detail, providing complete references for all citations. Refer to the lesson for client information.
Include the following sections:
1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
a. Describe your assigned client’s situation. Why are they presenting to the clinic? What medications are they currently taking?
b. Assess the applicable clinical practice guideline (CPG) for your assigned client linked on the same page in the lesson where the client case is located. What treatment is recommended by the CPG for your client’s situation?
c. Discuss your personal professional assessment of the client’s situation provided in the scenario. What pharmacological treatment is necessary and why?
d. Reflect on additional questions you have about your assigned client that may influence treatment. What else do you need to know? What follow-up assessments, labs, or conversations are required to ensure optimal health outcomes?