Migraine treatment in a nutshell Which medication to use depends on the patient profile

Prophylactic Treatment

Propranolol (Inderal LA) 60 mg bid, titrate up to 120 mg bid. Do not use in bradycardia, asthma. Elavil 10 mg, titrate up as tolerated. Watch for sedation, weight gain, anticholinergic side effect. Pamelor or Desipramine 25 mg hs, titrate up as tolerated. Watch for drowsiness, anticholinergic side effect. Topamax 25 mg bid, titrate up to 100 mg bid. Watch for drowsiness, tingling, weight loss. Depakote 250 mg bid, titrate up as tolerated. Watch for weight gain, tremor. Rare but can cause pancreatitis, thrombocytopenia. More information

Treatment of severe attacks

Naprosyn 500 mg prn po Zomig Nasal spray or 2.5 mg zmt. 1 to 2 per 24 hours. Migranal nasal spray: 1 spray into each nostril every 15 minutes, up to total of 4 sprays per attack. Phenergan 25 mg po or suppository prn for nausea. Reglan 10 mg prn for nausea Stadol Nasal Spray 1 spray to nostril as last resort. Potentially addictive. More information