Could be about anything from a horrible migraine to a cerebral aneurysm to brain masses.
Given her hx of smoking and taking BCPs, she's at high risk for blood clots. HPV can cause brains and encephalopathy. She's showing severe migraine-like symptoms (which appear to be refractory to her prescribed meds) which incidentally are also general s/s of increased ICP.
Is the BCPs and Imitrex the only meds she takes? Any antivirals? Illicit drug use? Pregnant again?
Onset? Symptom progression? Thorough neuro exam - any deficits? (other than the scatoma (shit for brains)?? - or is it scotoma (diminished vision)?), Anisocoria? Gaze deviation? Sided weakness? CPSS or LAPSS score (if applicable)? Vitals (especially BP and HR)?
See above
Unless the hospital was a 5 minute transport, I feel I'd have to make this an ALS call. Something about this girl just doesn't feel right. Call it gut instinct.
I would make her as comfortable as possible (duh!) and do what I can to relieve the pain and nausea. However, I doubt med control would approve of morphine (or nubain) or phenergan due to the potential of skewing the neuro exam. If she were to become obtunded, obviously assess her ability to maintain her airway and intervene as necessary. These are in addition to IV with NS TKO (or better yet, locked) and O2. Transport to a facility with neuro/stroke care (neurologist staffed as well as CT and MRI available in-house) capabilities is extremely preferred.