Wednesday, May 5, 2010

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Mild to moderate cases : drug of choice aspirin 1 g OD, ibuprofen 400 mg OD and sumatriptan 50 mg OD.
Use of these drugs must be limited to 15 days per month. They can be used in a combination formula for more effectiveness. Caffeine may also be added to these. Triptans are slightly more effective than aspirin.

Anti emetics can also be used. 10-20 mg metoclopramide stat IV dose or 10 mg TDS oral dose for 3-4 days. Domperidon 10 mg may also be used.

Ergot alkaloids are more effective for patients with very long migraine attacks or those with frequent recurrence compared to the medications used for acute attacks. e.g ergotamine (migril). It is recommended to take 2 mg at first sign of attack, then 1 mg every 30 mins for complete relief. Maximum of 6 mg per attack and 10 mg per week to avoid the vasoconstrictive side effects.

Opioids have limited efficacy in the treatment of migraine and must therfore be avoided.

Prophylaxis : beta blockers, calcium channel blockers, amitriptyline (the only antidepressant that has been consistently effective to treat migraine), valproic acid.

Acute attack in A&E : IV aspirin 1 g STAT or IV dihydroergotamine (D.H.E) 1 mg STAT (repeat another 1 mg IV of D.H.E after 1 hr if migraine symptoms persist)


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