CLINICAL HISTORY This is a 25-year-old (gravida 1, para 0) woman in her 10th week of pregnancy. She offers a 1-year history of migraine without aura. She describes a severe, one-sided throbbing associated with nausea, photosensitivity, and phonosensitivity. If the headache is not treated early, she also vomits. Both before the pregnancy and during the pregnancy thus far, the headaches have been...

n engl j med 363;1 nejm.org july 1, 2010 63 This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. T...