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PPT : Treatment of Menstrual Migraine: Focal Use Medications

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* Start taking the medicine about 1 day prior to usual symptoms
* Use doses which will allow rescue
* Keep diary to get timing down
* Continue treatment until risk is over
* Non-steroidal anti-inflammatory drugs (NSAIDS)
* Dihydroergotamine
o Nasal spray (Migranal®) 2mg
+ Rescue with 2 mg – begins to work within 30 minutes
o Injection (D.H.E. 45®) 1 mg
+ Rescue with 1 mg – dose can be repeated ,as needed, at 1-2 hour intervals for up to 3 mg in 24 hours

Treatment of Menstrual Migraine: Focal Use Medications
* Triptans
o Sumatriptan (Imitrex®): 25 mg twice a day (rescue with 50 or 100 mg)
o Naratriptan (Amerge®): 1mg twice a day
o Zolmitriptan (Zomig®): 2.5 mg twice a day (rescue with 5 mg)
o Rizatriptan (Maxalt®): 5 mg twice a day (rescue with 10 mg)
o Almotriptan (AxertTM): 6.25 mg twice a day (rescue with 12.5 mg)
o Frovatriptan (Frova®): 2.5 mg twice a day
o Eletriptan (Relpax®): 20 mg twice a day (rescue with 40 mg)

Treatment of Menstrual Migraine: Focal Use Medications

Treatment of Menstrual Migraine: Hormones
* Leuprolide 3.75 mg with estrogen/progesterone replacement
* Bromocriptine 2.5-5.0 mg/day
* Danazol 200-600 mg/day—day 3 through day 28
* Tamoxifen 5-15 mg

Oral Contraceptives and Headache
* Older tablets often worsened headaches
* Newer pills are often more tolerable
* Estrogen replacement during placebo-days may help with menstrual migraine
* Uninterrupted pill packs up to 3 months at a time can also reduce the frequency of menstrual migraine

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PPT : Treatment of Menstrual Migraine: Focal Use Medications.ppt


PPT : Treatment of Menstrual Migraine: Focal Use Medications Category : Migraines
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