9 Prophylactic drug treatment Consider in patients

9 prophylactic drug treatment consider in patients

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9 Prophylactic drug treatment Consider in patients with: > 2 attacks per week increasing headache frequency significant disability despite acute treatments cannot take suitable treatment Propranolol or amitriptyline are suitable first-choices: good evidence to support use for the prevention of migraine metoprolol, timolol and atenolol are alternative beta-blockers Sodium valproate or topiramate are suitable second- line: good evidence of efficacy clinical utility of topiramate limited and specialist input needed
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10 Summary Migraine: a primary episodic headache disorder characterised by neurological, gastrointestinal and autonomic changes (aura experienced by around 25% of patients) affects about 10% of the population, with women being affected more than men Treatment: start acute treatment with simple analgesic + anti-emetic early triptans are effective second-line options but should not be taken too early in an attack differences between triptans are small but may be clinically relevant to the individual patient Consider prophylaxis in those with frequent/worsening attacks
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