instruction: hello doctor I have migraines daily for the past two months it gets controlled with painkillers and worsens with movement other than that no other symptoms like dizziness or vomiting are present the pain is usually moderate to severe sometimes one sided and sometimes full head pain I am taking paracetamol or ibuprofen for pain please help
output: hello I understand your concern and would explain that considering your aggravated situation it would be reasonable to start preventive therapy for migraine in this regard I would recommend starting topiramate 50 my twice daily it is recommended starting 25 my daily and increase each week by 25 my up to 50 my twice daily this will help reduce the frequency and severity of migraine headaches if you do not tolerate this drug or it does not help reduce the frequency of headaches within the first month I would recommend considering other treatment options like verapamil or amitriptyline you should discuss with your doctor on the above treatment options there is no need to perform any tests as this is a chronic headache and painkillers still help I hope this helps