A patient with history of migraines comes to the ER with a severe headache. What medication is most appropriate for acute management?

In the context of acute management of a migraine headache, sumatriptan is the most appropriate medication. Sumatriptan is a triptan, a class of drugs specifically designed to treat migraine attacks. It works by stimulating serotonin receptors in the brain, leading to vasoconstriction of dilated intracranial blood vessels and the alleviation of headache symptoms. This makes it particularly effective for patients who have a history of migraines and are experiencing an acute attack, as it targets the underlying physiological mechanisms of a migraine.

While ibuprofen and acetaminophen can be used for general headache relief, they are not as effective as sumatriptan for migraines, particularly for severe cases. Caffeine, while sometimes included in combination medications for migraines, is not a standalone treatment for acute episodes and can lead to rebound headaches if used excessively. Therefore, for a patient with a severe migraine headache, sumatriptan stands out as the most appropriate option for acute management.