PHRM 211 Lecture 20: NEUR Therapeutics of Migraine Medications (Part 4)
Document Summary
Asa 1000 mg weak evidence that > placebo. Other: acupuncture, heat, ice, manual therapies, rest, biofeedback. Not recommended: butalbital and codeine products, muscle relaxants. Amitriptyline 10 mg hs (titrate to max 100 mg hs) Acetaminophen 250 mg/asa 250 mg/caffeine 65 mg (not available in canada) Combination of caffeine 64-200mg + simple analgesics > simple analgesics alone. Sumatriptan 6 mg sc x1, may repeat in 1h. Oxygen 100% via facial mask 12-15 l/min x 15 min. Sumatriptan 20 mg in, zolmitriptan 5-10 mg in. Prophylaxis 1st line: verapamil 360 mg daily divided bid or tid (target dose) Corticosteroids (prednisone, dexamethasone) pulse and taper or continuous therapy depending on pattern of ha. Reasonable first line choices for the treatment of mild to moderate migraine attacks. Not good option if is vomiting could combine with antiemetic. Asa + metoclopramide may be as effective as sumatriptan for mild-moderate attacks. Usually no role, may have benefit in pt with comorbid migraines.
