See also
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
