Migraine pharmacologic abortive therapy

MIGRAINE PHARMACOLOGIC ABORTIVE THERAPY

  • EVALUATE IF N/V to select 1st drug and route

  • Antiemetics 1st if N/V ( Metochlopramide, Prochlorperazine)

  • 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)

  • Others to consider 2nd/3er line: Ziprasedone, Valproate, IV Mg

MIGRAINE PHARMACOLOGIC PROPHYLACTIC THERAPY (consider if pt has 3+attacks / month)

  • beta blockers (propanolol)

  • CCB (Verapamil)

  • TCA’s

  • Dexametasone, methylprednisolone

  • SSRI/ SNRI

  • OTHERS: Botulinum Toxin to consider if more than 15 (really??) attacks/month