Correct Diagnosis, Wrong Medication, Unusual Adverse Event

A 37 year old white woman with a well-known history of migraine headaches presented to an urgent care center with a chief complaint of severe headache with associated nausea that was unrelieved by medication that she had at home. She had taken Axert® (almotriptan) at home and repeated it once, without any improvement in her symptoms; she typically had good results with this medication. Upon presentation to the urgent care center, she had been given Zofran 4 mg disintegrating tablet with minimal improvement in her nausea. She rated the pain of her headache as eight (8) on a scale of 1-10. The patient reported awakening with the headache on the morning of presentation. She reported pain “all over” her head, which began in the frontal region; she admitted that this was not typical of her migraine headaches which usually began unilaterally in her temple area. In spite of the almotriptan, her headache worsened while she was taking a shower. When another dose of almotriptan failed to provide any relief, she was brought into the urgent care by her husband.