Migraine Headache
Posted by dkwinter

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Hx
     Episodes of throbbing temporal pain
     Lasts a few hours
     Nausea
     Vomiting
Hx (complicated migraine)
     Aura of flashing light
     Aura of weakness or numbness for a period of minutes
Tx
     Abortive
          First line for acute migraine
               Prescription-strength NSAIDs (e.g. Toradol 30mg IM)
               Combo of Aspirin/Acetaminophen/Caffeine
          Second line
               Triptans (5HT1 agonists)
          If nausea and vomiting are prominent symptoms
               Antiemetics
               Parenteral hydration
          Rescue treatments for if initial therapies fail
               Combination of NSAIDs and triptans, ideally non-orally
               Ergotamine (less efficacy and fewer side effects)
               Phenothiazines
               Opioids
               Corticosteroids (off-label use)
     Preventive
          Nonpharmacologic therapy
               Biofeedback-assisted relaxation 
               Cognitive behavior therapy
          Once an effective pharmacologic treatment is found, most experts recommend continuing it for 4 to 6 months before attempting to weak. Some patients will require indefinite treatment.
          Women with menstrual migraine should be considered for cycle control
          Pharmacologic
               Anticonvulsants
                    Valproate
                    Topiramate
                    Tricyclic antidepressants
                    Beta-blockers
                    Gabapentin (off-label)
                    Lamotrigine may be useful in preventing auras (good if frequent and troublesome)
                    Venlafaxine