Migraine with aura in a 28-year-old woman on a combined oral contraceptive
Write a prescription for migraine with aura and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
hard7 scoring rules
- Patient
- 28 years, female, 62 kg
- Diagnosis
- Migraine with aura
- Renal function
- eGFR 105 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- ethinylestradiol/levonorgestrel 30/150 micrograms once daily
The scenario
Patient B-217 is a 28-year-old woman who presents with a 2-year history of migraine. She describes attacks that occur about 8 days per month. Before the headache, she experiences visual scintillations lasting 20-30 minutes. The headache is unilateral, pulsating, and severe, associated with nausea, vomiting, and photophobia, and lasts up to 12 hours. She has tried paracetamol for attacks, with no relief. Her only regular medication is a combined oral contraceptive (ethinylestradiol 30 micrograms/levonorgestrel 150 micrograms), which she uses for contraception. She is otherwise well, with no allergies, and is not pregnant. Examination reveals a blood pressure of 118/76 mmHg, heart rate 68 bpm, and no neurological deficit. Serum creatinine is 0.8 mg/dL, eGFR 105 mL/min/1.73 m², and hepatic function is normal. Her weight is 62 kg. Task: prescribe appropriate acute treatment for her migraine attacks. Also, comment on any changes you would make to her current medication and whether prophylactic treatment is indicated, prescribing it if so.
Your task
No significant past medical history. No known drug allergies.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
7 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
Log in to prescribe for "Migraine with aura in a 28-year-old woman on a combined oral contraceptive"
A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.