Triptan Selection - Migraine Management
Choosing triptans:
 • Reponse to given triptan do not predict to others
 • Try each triptan three times
 • Use < 10 times per month to avoid medication-overuse headache
Rapidly progressing migraine attack:
 • Subcutaneous sumatriptan 6 mg or nasal spray sumatriptan 10 mg
 • Intranasal zolmitriptan 5mg
 • Fast-acting oral triptan preparation- eletriptan 40mg, rizatriptan 10 mg, zolmitriptan 2.5 mg
 • An additional pro-kinetic for example domperidone, 10mg
Lack of triptan response:
 • Consider preventive
 • Try higher dose
 • Alternative triptan
 • Alternative formulation (subcutaneous, intranasal)
 • Combination therapy with NSAID (ibuprofen 800mg TDS or naproxen 500mg bid)

doi:10.1136/practneurol-2015-001167

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