MIGRAINE-ACUTE MANAGEMENT

SUMMARY

1. Acetaminophen, aspirin, and NSAIDs are effective in some patients, especially if the migraine is mild and infrequent.

2. Next is the "triptans": Sumatriptan (Imitrex®), Almotriptan (Axert®), Zolmitriptan (Zomig®), Eletriptan (Relpax®), Rizatriptan (Maxalt®), Frovatriptan (Frova®), Naratriptan (Amerge®).

3. Because of risk of inducing ischemia, do not use triptans in: complicated or basilar migraines, CHD or Prinzmetal angina, hx of stroke, uncontrolled BP, pregnancy.

4. Also, do not combine triptans with MOAI or use within 24 hours of ergot drugs. Instead of the triptans, IV prochlorperazine or
metoclopramide also is effective for termination of migraine in patients who present to the emergency department with vomiting.

5. Dihydroergotamine (DHE) can be effective, but must be avoided in patients with CHD, HTN, vasculopathy & liver or kidney disease.

6. Increased use of any medication, including triptans and NSAIDs causes rebound called "medication overuse headaches." Patients should be instructed not to take analgesics more than 10 days per month.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].