One of the first line choices up to 40 Inderal Timolol

One of the first line choices up to 40 inderal timolol

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One of the first line choices (up to 40% reduction)—Propranolol (Inderal), Timolol (Blocadren) 60-80 mg of Propranolol initially and gradually increases every 3-4 days (max 240mg) for 3 mo—Pulse <50mg or SBP <100mg (reached max) Treatment should be reassessed every 6 mo; tapering slowly (over a week) to prevent withdrawal HA; for children, closely monitored and consult w/ pediatric neurologists before initiating & during ADRs: fatigue, lethargy, depression (no first line for patients w/ depression) Contraindication in CHF, COPD, peripheral vascular disease, DM or WPW syndrome Pregnancy C (safer than any other agents) TCA Amitriptyline (Elavil) effective in reducing frequency, severity, duration of migraine at lower dose 10mg/D at bedtime and increase every 2 wk up to 20-50mg ADRs: drowsiness, dry mouth, wt gain, constipation, orthostatic hypotension Contraindication in narrow-angle glaucoma, urinary retention, pregnancy, breastfeeding, concurrent MAOIs Antiepilep tic Drugs (AEDs) Doivalproex (Valproate): require baseline LFT, PLT count, Bleeding time for thrombocytopenia, routine lab monitoring Gabapentin: One of the recommended migraine prophylaxes; ADRs generally tolerated, fatigue, somnolence, wt gain Topiramate: recommended migraine prophylaxis; ADRs wt loss, somnolence, fatigue, kidney stones NSAIDS Naproxen sodium—particularly effective in menstrual migraines starting the week before menses and continue for a week; ADRs higher risk of causing nephrotoxicity or gastrointestinal problems CCBs Common preventive therapy but not the first choice Verapamil (Calan): can be used for the first-line for patients w/ HTN or intolerant BBs Contraindication in pregnancy, parkinson’s dz, depression Ergot Metysergide (Sansert) not common due to retroperitoneal fibrosis; Drug free
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derivateiv e period 3-4 weeks needed every 6 mo Botulinu m Toxin Head and neck muscle area, repeated every 12 weeks Non-pharmacological management o Identify migraine triggering factors and avoidance o Alternative therapies Herbs (feverfew & butterbur) Vitamins (Riboflavin) Coenzyme Q10 o Biofeedback Tension-type headache : band like pressure, persistent dull pain bilaterally, nonpulsating last 30 min -7days, not worsened by exercise Goals: decrease frequency, severity of HA, provide acute relief Acute therapy o
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  • Spring '14
  • Henrikson,J
  • migraine, Ergotamine

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