PHRM 211 Lecture Notes - Lecture 20: Medication Overuse Headache, Migraine Treatment, Therapy
Document Summary
Treatment of severe, refractory migraine pain (i. e. status migrainosus) Treatment of severe nausea, vomiting, and subsequent dehydration. Detoxification from overuse of combination analgesics, ergots, or opioids. Significant disability or diminished qol despite appropriate acute treatment. Preventive medications are considered effective if the frequency of attacks are reduced by 50% Start low and titrate up to minimize side effects. Allow 8 weeks for benefit once at target dose. Reasonable to leave on prophylactic therapy for 6-12 months then consider slowly tapering off with monitoring for worsening migraines. Consider combo therapy from different classes if partial responders & dose limiting adrs. Becoming discouraged too quickly due to side effects. Not titrating to target dose when drug is well tolerated. Not waiting long enough before abandoning the drug. Trying several preventative treatments without having gone through withdrawal in the case of medication overuse. Depending entirely on medication without improving lifestyle habits and the control of other medical conditions.
