Maria's Headache lecture

• Appropriate meds for mild to moderate HA w/o nausea


  1. Mild analgesia → NSAIDs or acetaminophen, caffeine containing products, aspirin
  2. Can add triptan if mild analgesia fails
• Appropriate meds for moderate to severe HA w/o nausea

  1. Oral triptans
  2. NSAIDs → motrin, naproxen, indomethacin (PR form)
• Appropiate meds for migraine w/ nausea

  1. Sumatriptan/Imitrex (SQ, intranasal, or PO)
  2. Rizatriptan/Maxalt (ODT)
  3. Zolmitriptan/Zomig (oral or intranasal)
• Treatment approach for PREGNANT patient w/ migraine

  1. First line: Acetaminophen, alone or in combo w/ metoclopramide or caffeine
  2. Second line: Aspirin, NSAIDs
  3. Third line: Opioids
  4. HARMFUL in breastfeeding = ergotamines, opioids, sumatriptans
• Identify appropriate anti-emetic meds

  Prochlorperazine, Metoclopramide, Promethazine, Chlorpromazine
• What to give to prevent recurring migraine headaches

  • Long acting triptan → Frovatriptan
  • Dexamethasone
• What medications could potentially cause a rebound headache

  1. Highest w/ opioids
  2. Lowest w/ NSAIDs
  3. Unclear w/ triptans
  4. Limit meds to less than 10 days per month