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Migraine (Complications (Medication overuse headache, Stroke Ischemic…

- - - - Antiemetics
        Indication: 1L alongside simple analgesia if needed for N+V
        E.g. metaclopramide, domperidone
        MOA: DA antagonists (centrally acting)
        NB. combined analgesia + antiemetics are available e.g. MigraMax (aspirin + metaclopramide), Paramax (paracetamol + metaclopramide)
      - Simple analgesia
        Indication: 1L plus triptan
        E.g. paracetamol, NSAIDs (PO, suppository)
        CI: asprin if <16y (Reye's syndrome) or breastfeeding; NSAIDs in 3rd trimester pregnancy
      - Ergotamines
        Indication: 3L
        E.g. ergotamine tartrate, dihydroergotamine (IV)
        MOA: 5HT and D2 agonist
        SE: nausea, rebound headache
      - Triptans
        Indication: 1L plus simple analgesia
        E.g. sumatriptan, zolmatriptan (PO, melts, SC, nasal spray)
        MOA: 5HT agonists
        SEs: Chest discomfort, jaw/shoulder/neck tightness,
        parasthesia, fatigue, dizziness
        CI: CVD, PVD, stroke, liver disease, pregnancy
        Interactions: MAOIs/SSRIs (seratonin syndrome)
  - - - Oral therapy
        
        5HT2 antagonists
        Indication: 2L
        E.g. pizotifen, amitriptylline
        MOA: block 5HT2, blocking pain signals
        SEs: dry mouth, drowsiness
        
        AEDs
        Indication: 1L (pt pref)
        E.g. topiramate
        SEs: weight change, liver dysfunction, teratogenicity,
        drug interactions (COCP)
        
        B-blockers
        Indication: 1L in pts with co-existing anxiety or HTN
        E.g. propanolol
        MOA: block B2 receptors, causing vasodilatation
        SEs: Postural hypotension, fatigue, cold limbs, vivid dreams
        CI: asthma, COPD, PVD, uncontrolled HF
      - Nerve/muscle injections
        Indication: specialist use
        E.g. Greater occipital nerve blocks/stimulators,
        botulinum toxin
      - Acupunture
        Indication: oral therapy not worked
        E.g. 10 sessions over 508wk