neuro clinics 35 migraine 2
TRANSCRIPT
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Dr Pratyush Chaudhuri
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Drug Dose Route
Aspirin 500-650 mg Oral
Paracetamol 500 mg-4 g Oral
Ibuprofen 200- 300 mg Oral
Diclofenac 50-100 mg Oral/IM
Naproxen 500-750 mg Oral
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Drug Dose Route
Ergot alkaloids
Ergotamine 1-2 mg/d; max-6 g/d
Oral
Dihydroergotamine
0.75-1 mg SC
5-HT receptor agonists
Sumatriptan 25-300 mg
6 mg
Orally
SC
Rizatriptan
Naratriptan
10 mg
1mg, 2.5mg
Orally
orally
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Drug Dose (mg)/d RouteDomperidone 10-80 mg Oral
Metoclopramide 5-10 mg Oral/IV
Promethazine 50-125 mg Oral/IM
Chlorpromazine 10-25 mg Oral/IV
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Drugs Dose (mg/d)
1. Betablockers Propranolol (ciplar,
betacap)40-320
1. Calcium Channel Blockers Flunarizine (sibelium) Verapamil (Calaptin)
10-20
120-480
1. TCAs Amitriptyline (Libotryp) 10-20
1. SSRIs Fluoxetine 20-60
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Drugs Dose (mg/d)
1. Anti-convulsant Sodium valproate 600-1200
1. Anti-histaminic Cyproheptadine 4-8
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Cephalalgia 1990; 10: 101-105*p < 0.001
Variable Placebo (run in) Propranolol-LA
160
Propranolol-LA
80
Frequency (per
month)
6.1 3.4* 3.9*
Side effects n = 27 n = 18
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Headache 1998; 28: 607-611
Parameter Baseline End-periodSeverity score 11.1 6.7*
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48 50
0
10
20
30
40
50
60
70
Flunarizine (p<0.01) Propranolol (p<0.0005)
No. of attacks reduced by more than 50%
% o
f Pat
ient
s
Headache 1989; 29: 218-223
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1.6 1.6
1.4
1.2*
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Flunarizine Propranolol
Sev
erity
sco
re
Baseline
16 weeks
* p<0.05Headache 1989; 29: 218-223
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That’s all folks!