Migraine
From IDWiki
Criteria
- Any two of:
- unilateral
- throbbing
- worse with activity
- moderate or severe
- Plus any one of:
- nausea or vomiting
- photophobia/phonophobia
Management
Acute/Abortive
- Goal is to be headache-free within 1 or 2 hours
- Maximum 2-3 days weekly of medication to prevent rebound headache
- Abortive therapy within an hour: any triptan
- Abortive therapy during pain: NSAIDs, acetaminophen, metoclopramide
- Mild-moderate
- Diclofenac, naproxen
- Mod-severe
- NSAID + triptan
ER protocol
- A combination of the following, base on severity:
- Normal saline 1L IV bolus
- Prochlorperazine 10mg IV
- Metoclopramide
- Diphenhydramine 25mg IV
- Ketorolac 30mg IV
- Dexamethasone 10mg IV
Preventative
- Headache diary to identify triggers like stress, hormones, not eating, weather, etc.
- Start if ≥4 severe headaches per month, for nocturnal/morning headaches, or when interfering with activities
- Beta-blockers like propanolol, metoprolol, atenololtimolol,
- TCAs like amitriptyline, venlafaxine
- Anti-epileptics like valproate
- Candesartan, lisinopril
- Butterbur (liver toxicity), riboflavin, magnesium citrate, coenzyme Q, feverfew