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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