MIGRAINE PHARMACOLOGIC ABORTIVE THERAPY
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EVALUATE IF N/V to select 1st drug and route
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Antiemetics 1st if N/V ( Metochlopramide, Prochlorperazine)
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Pain Management : Ladder: Acetaminophen/ NSAIDS >>Triptans or Ergotamine >> Butorphanol (contraindication for Tript/Ergots). Remember not to use Triptans + Ergot derivatives on the same day (Risk of Ischemic event !!) . Tramadol is highly emetogenic (avoid)
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Others to consider 2nd/3er line: Ziprasedone, Valproate, IV Mg
MIGRAINE PHARMACOLOGIC PROPHYLACTIC THERAPY (consider if pt has 3+attacks / month)
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beta blockers (propanolol)
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CCB (Verapamil)
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TCA’s
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Dexametasone, methylprednisolone
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SSRI/ SNRI
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OTHERS: Botulinum Toxin to consider if more than 15 (really??) attacks/month