Treatment of Migraine

Abortive Rx: 5-HT1 agonists (triptans) effective if given early in migraine attack; Abortive: The goal of abortive treatment is to stop a migraine once it starts. contraindicated if motor aura, CAD, prior stroke. Also consider acetaminophen, caffeine, NSAIDs (ketorolac), steroids, Mg, metoclopramide, prochlorperazine, valproate, dihydroergotamine (caution if CAD, recent triptan use). Avoid butalbital, opioids.

• Prophylaxis: AEDs (topiramate, VPA), β-blockers (propranolol first-line), TCAs (amitriptyline), Mg, B2, botox, anti-CGRP, & receptor mAbs (Lancet 2021;397:51)