A patient presents to the office with a history of hypertension and migraine headache. His blood pressure is not well controlled at 142/90. He has failed to control his headache pain with indocin. He has headaches several times per week and wants treatment to prevent headaches. Your best option from the choices below is

A. Sumatriptan (Imitrex): Sumatriptan is used acutely to treat migraine attacks, not for prevention. Additionally, it is contraindicated in patients with uncontrolled hypertension because it can cause vasoconstriction and increase cardiovascular risk. B. Propranolol (Inderal): Propranolol is a non-selective beta-blocker that is first-line for migraine prophylaxis. It can both lower blood pressure and reduce the frequency and severity of migraines, making it ideal for a patient with comorbid hypertension. C. Ergotamine (Cafergot): Ergotamine is used for acute migraine treatment and is contraindicated in patients with uncontrolled hypertension due to potent vasoconstrictive effects, which increase the risk of ischemic events. D. Amitriptyline (Elavil): Amitriptyline is a tricyclic antidepressant sometimes used for migraine prevention, especially when comorbid insomnia or depression exists. While effective, it does not address hypertension and may worsen cardiac risk in some patients, making propranolol a safer first choice.