Chapter 015. Headache (Part 9) pps

Headache Part 9 Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; HT, 5-hydroxytryptamine.. In general, an adequate dose of whichever agent is chosen should be used as soon

Chapter 015 Headache

(Part 9)

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; HT,

5-hydroxytryptamine

In general, an adequate dose of whichever agent is chosen should be used

as soon as possible after the onset of an attack If additional medication is required within 60 min because symptoms return or have not abated, the initial dose should

be increased for subsequent attacks Migraine therapy must be individualized; a standard approach for all patients is not possible A therapeutic regimen may need

to be constantly refined until one is identified that provides the patient with rapid, complete, and consistent relief with minimal side effects (Table 15-6)

Table 15-6 Clinical Stratification of Acute Specific Migraine Treatments

Clinical Situation Treatment Options

Failed NSAIDS/analgesics First tier

Infrequent headache

mg

Early nausea or difficulties

taking tablets

Zolmitriptan 5 mg nasal spray

Headache recurrence Ergotamine 2 mg (most effective

PR/usually with caffeine)

Eletriptan 40 mg

Tolerating acute treatments

poorly

Naratriptan 2.5 mg

Early vomiting Zolmitriptan 5 mg nasal spray

Menses-related headache Prevention

Triptans

Very rapidly developing

symptoms

Zolmitriptan 5 mg nasal spray