Techniques in Regional Anesthesia & Pain Management
Volume 13, Issue 1 , Pages 9-15, January 2009

Acute treatment of migraine headache

  • Marisa Chang, MD

      Affiliations

    • Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, California
    • Corresponding Author InformationAddress reprint requests and correspondence: Marisa Chang, MD, UCLA Department of Neurology, Neurological Services, 300 Medical Plaza, Suite B200, Los Angeles, CA 90095-6975
    • ,
  • Alan M. Rapoport, MD

      Affiliations

    • Department of Neurology, The David Geffen School of Medicine at UCLA, Los Angeles, California
    • The New England Center of Headache, Stamford, Connecticut

The purpose of this article is to provide practitioners with the tools necessary to diagnose and treat acute migraine. The current diagnostic criteria for migraine are outlined. Pearls to distinguish migraine from the other primary headaches, such as tension-type headache and cluster headache, are provided. The importance of the headache history, plus indications for neuroimaging, are presented. Readers will be taught how to take an effective headache history. General principles of treatment, including appropriate medication selection, medication dosing and route of administration, medication contraindications, drug interactions, and tips to optimize success are covered. A stratified care plan is outlined. Acute migraine treatment options are discussed, including dosing, side effects, and summary recommendations for simple analgesics, combination analgesics, opiates, corticosteroids, and the migraine specific ergots and triptans. The 7 available triptans are covered in detail and tips for selecting the most appropriate triptan for specific situations are delineated. Preventative and future treatments are briefly discussed.

Keywords: Migraine, Headache, Triptan, Acute treatment, Diagnostic criteria for headaches, Headache history

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PII: S1084-208X(09)00004-4

doi:10.1053/j.trap.2009.03.003

Techniques in Regional Anesthesia & Pain Management
Volume 13, Issue 1 , Pages 9-15, January 2009

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