Migraine

Question 1

aspirin, APAP & NSAIDS

Answer 1

for mild to moderate attacks (no more than 3 times/week for NSAIDS and aspirin)

Question 2

Narcotics

Answer 2

reserved for moderate to severe attacks when other methods are contraindicated

Question 3

metoclopramide

Answer 3

antiemetic, also helps with the h/a pain

Question 4

ergotamines/dihydroergotamines

Answer 4

give antiemetics before injectable therapy; lots of adverse effects

Question 5

Triptans

Answer 5

if pt experiencing nausea or vomiting use a non-oral triptan (e.g. ODT);
DDIs: serotonergic drugs should be used with caution; use a triptan that is not metabolized by MAO if pt is on another serotonergic drug (e.g. naratriptan, frovatriptan, eletriptan)
Do not use within 24 hours of ergot derivatives

Question 6

antiemetics

Answer 6

administer 15-30 min before abortive tx, if needed. metoclopramide, chlorpromazine, and serotonin antagonists

Question 7

AEDs

Answer 7

for prevention
valproate, topiramate have proven efficacy
carbamazepine has less evidence
gabapentin has conflicting data
tiagabine, levetiracetam, zonisamide may have immediate benefit but further study needed

Question 8

Antidepressants

Answer 8

for prevention, in order of most evidence to least:
amitriptyline, venlafaxine
nortriptyline: less sedating with fewer anticholinergic ADEs
fluoxetine, fluvoxamine

Question 9

Other antihypertensives

Answer 9

for prevention

lisinopril, candesartan, clonidine, guanfacine, CCBs (nicardipine, nifedipine, nimodipine, verapamil)

Question 10

B-Blockers

Answer 10

for prevention
propranolol (FDA indication), metoprolol, timolol (FDA indication)
atenolol, nadolol
nebivolol, pindolol
biosprolol

Question 11

Triptans for short-term prevention of mentrual migraines

Answer 11

frovatriptan

naratriptan, zolmitriptan

Question 12

Pregnancy

Answer 12

acetaminophen first-line

then APAP/metoclopramide or APAP/codeine

Question 13

Children

Answer 13

> 6 years: ibuprofen or APAP

>12 years: sumatriptan nasal spray