Neuro clinics 35 migraine 2

Dr Pratyush Chaudhuri

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

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

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

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

Drugs Dose (mg/d)

1. Anti-convulsant Sodium valproate 600-1200

1. Anti-histaminic Cyproheptadine 4-8

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

Headache 1998; 28: 607-611

Parameter Baseline End-periodSeverity score 11.1 6.7*

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

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

That’s all folks!