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Migraine and Headache Treatments

May 07, 2012

Download Migraine and Headache Treatment Chart

Migraine and Headache Treatment Chart (download)

MIGRAINE AND HEADACHE TREATMENTS

Generic & Class	Brand & Company	Strength		Formulations†	Usual Dose
ANALGESIC + BARBITURATE
acetaminophen	DOLGIC PLUS (Victory Pharma)	750mg	Rx	tabs	Children: not recommended. Adults: 1 tab every 4 hrs; max 5 tabs/day.
butalbital		50mg
caffeine		40mg
acetaminophen	ESGIC PLUS (Mikart)	500mg	Rx	scored tabs; caps	Children: not recommended. Adults: 1 cap or tab every 4 hours as needed.
butalbital		50mg
caffeine		40mg
acetaminophen	FIORICET (Watson)	325mg	Rx	tabs	Children: not recommended. Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day.
butalbital		50mg
caffeine		40mg
acetaminophen	PHRENILIN (Valeant)	325mg	Rx	tabs	Children: not recommended. Adults: 1–2 tabs every 4 hours; max 6 tabs daily.
butalbital		50mg
ANALGESIC + BARBITURATE + OPIOID
acetaminophen		FIORICET w. CODEINE (Watson)				325mg	CIII	caps	Children: not recommended. Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day.
butalbital	50mg
caffeine	40mg
codeine phosphate	30mg
ANALGESIC + SALICYLATE
acetaminophen	EXCEDRIN MIGRAINE (Novartis Consumer Health)	250mg	OTC	tabs	Children: not recommended. Adults: Take with full glass of water. ≥18yrs: 2 tabs every 6 hours as needed; max 8 tabs/day for 2 days.
aspirin		250mg
caffeine		65mg
ANALGESIC + SEDATIVE + SYMPATHOMIMETIC
acetaminophen	MIDRIN (Women First Healthcare)	325mg	CIV	caps	Children: not recommended. Adults: Tension: 1–2 caps every 4 hours; max 8 caps/day. Migraine: 2 caps once then 1 cap every 1 hour; max 5 caps/12 hours.
dichloralphenazone		100mg
isometheptene mucate		65mg
ANALGESIC + SYMPATHOMIMETIC
acetaminophen	MIGRATEN (Azur Pharma)	325mg	Rx	caps	Children: not recommended. Adults: Tension: 1–2 caps every 4 hours; max 8 caps/day. Migraine: 2 caps at once, then 1 cap every hour until relieved; max 5 caps/12 hours.
caffeine		100mg
isometheptene mucate		65mg
BARBITURATE + SALICYLATE
aspirin	FIORINAL (Watson)	325mg	CIII	tabs; caps	Children: not recommended. Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day.
butalbital		50mg
caffeine		40mg
BARBITURATE + SALICYLATE + OPIOID
aspirin	FIORINAL w. CODEINE (Watson)	325mg	CIII	caps	Children: not recommended. Adults: 1–2 tabs or caps every 4 hours as needed; max 6/day.
butalbital		50mg
caffeine		40mg
codeine phosphate		30mg
ERGOT ALKALOID
dihydroergotamine mesylate	D.H.E. 45 (Valeant)	1mg/mL	Rx	IM, IV, or SC inj	Children: not recommended. Adults: 1mL IV at 1 hour intervals; max 2 doses/day. Or, 1mL IM or SC at 1-hour intervals; max 3 doses/day. For all: max 6 doses/week. Do not use chronically.
dihydroergotamine mesylate	MIGRANAL** (Valeant)	4mg/mL	Rx	nasal spray	Children: not recommended. Adults: 1 spray in each nostril, repeat 15 minutes later; max 6 sprays/24 hrs and 8 sprays/wk.
ergotamine tartrate	(various)	1mg	Rx	tabs	Children: not recommended. Adults: 2 tablets at onset of attack, then 1 tablet every ½ hour if needed; max 6 tabs/attack, 10 tabs/week.
caffeine	(various)	100mg	Rx	tabs
ergotamine tartrate	(various)	2mg	Rx	rectal supp	Children: not recommended. Adults: 1 supp rectally at onset of attack, then 1 supp after 1 hour if needed; max 2 supps/attack, 5 supps/week.
caffeine	(various)	100mg	Rx	rectal supp
NON-STEROIDAL ANTI-INFLAMMATORY (NSAID)
diclofenac potassium	CAMBIA (Nautilus)	50mg	Rx	Buffered pwd for oral soln	Children: <18yrs: not recommended. Adults: ≥18yrs: mix 1 packet (50mg) with 30–60mL of water only and drink immediately.
ibuprofen	ADVIL MIGRAINE (Wyeth Consumer Healthcare)	200mg	OTC	liquid-filled caps	Children: <18yrs: not recommended. Adults: ≥18yrs: Usually 400mg once daily.
ibuprofen	MOTRIN MIGRAINE PAIN (McNeil Consumer & Specialty)	200mg	OTC	caplets	Children: <18yrs: not recommended. Adults: ≥18yrs: Usually 200mg–400mg once daily.
SELECTIVE 5-HT_1B/1D RECEPTOR AGONIST
almotriptan (malate)	AXERT (Janssen)	6.25mg, 12.5mg	Rx	tabs	Adults and Children: <12yrs: not recommended. ≥12yrs: 6.25mg or 12.5mg single dose; may repeat once after 2 hours; max 25mg/24hrs. Hepatic or severe renal impairment (CrCl 10–30mL/minute) or concomitant potent CYP3A4 inhibitors (eg, ketoconazole): initially 6.25mg once; max 12.5mg/24 hours. The safety of treating an average of more than 4 headaches over 30 days is not established.
eletriptan HBr	RELPAX (Pfizer)	20mg, 40mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: 20mg or 40mg once. Reevaluate if no response. May repeat once after 2 hours; max 80mg/day. The safety of treating an average of more than 3 headaches in a 30-day period has not been established.
frovatriptan (as succinate)	FROVA (Endo)	2.5mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: 2.5mg with fluids; may repeat once after 2 hours; max 7.5mg/24 hours. Reevaluate if no response after 1st dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established.
naratriptan HCl	AMERGE (GlaxoSmithKline)	1mg, 2.5mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: 1mg or 2.5mg with fluids; may repeat once after 4 hours; max 5mg/24 hours. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established. Mild-to-moderate renal or hepatic impairment: consider lower initial dose; max 2.5mg/24 hours.
rizatriptan (as benzoate)	MAXALT (Merck)	5mg, 10mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: Initially 5 or 10mg; may repeat after 2 hrs; max 30mg/day. Concomitant propranolol: use 5mg dose; max 3 doses/day. The safety of treating, on average, more than 4 headaches in a 30-day period has not been established.
rizatriptan (as benzoate)	MAXALT-MLT* (Merck)	5mg, 10mg	Rx	ODT
sumatriptan (as succinate)	ALSUMA (Meridian Med Tech)	6mg/0.5mL	Rx	soln for SC inj	Children: <18yrs: not recommended. Adults: ≥18yrs: one (6mg) dose SC to the lateral thigh or upper arm only. Reevaluate if no response. May repeat after 1 hour; max two (6mg) doses in 24 hours.
	IMITREX INJECTION (GlaxoSmithKline)	4mg/0.5mL, 6mg/0.5mL	Rx	SC inj	Children: <18yrs: not recommended. Adults: ≥18yrs: 6mg SC (may start at lower dose if 6mg not tolerated). Reevaluate if no response. May repeat after 1 hour; max two 6mg doses in 24 hours.
	IMITREX NASAL SPRAY (GlaxoSmithKline)	5mg per spray, 20mg per spray	Rx	nasal spray	Children: <18yrs: not recommended. Adults: ≥18yrs: 5mg, 10mg, or 20mg once. Reevaluate if no response. May repeat once after 2hrs; max 40mg/day. The safety of treating an average of more than 4 headaches in a 30-day period has not been established.
	IMITREX TABLETS (GlaxoSmithKline)	25mg, 50mg, 100mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: 25–100mg once, swallow whole with fluids as soon as possible after migraine onset; may repeat dose at intervals of at least 2hrs, max 200mg/day; or single-dose tablets up to 100mg/day if injection has been used. Hepatic dysfunction: max 50mg/dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established.
	SUMAVEL DOSEPRO (Zogenix)	6mg/0.5mL	Rx	soln for SC inj	Children: <18yrs: not recommended. Adults: ≥18yrs: one DosePro (6mg) SC to the abdomen or thigh only. Reevaluate if no response. May repeat after 1 hour; max two DosePro (6mg) doses in 24 hours.
zolmitriptan	ZOMIG (Impax)	2.5mg+, 5mg	Rx	tabs	Children: <18yrs: not recommended. Adults: ≥18yrs: Initially 2.5mg or lower once. If headache returns, may repeat after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Hepatic impairment: use low dose. ZMT: dissolve on tongue and swallow without water.
	ZOMIG NASAL SPRAY (Impax)	5mg per spray	Rx	nasal spray	Children: <18yrs: not recommended. Adults: ≥18yrs: 5mg once. If headache returns, may repeat once after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 4 headaches in a 30-day period has not been established. Hepatic impairment: use low dose oral form.
	ZOMIG-ZMT* (Impax)	2.5mg, 5mg	Rx	ODT	Children: <18yrs: not recommended. Adults: ≥18yrs: Initially 2.5mg or lower once. If headache returns, may repeat after 2 hrs; max 10mg/day. Reevaluate if no response after 1st dose. The safety of treating an average of more than 3 headaches in a 30-day period has not been established. Hepatic impairment: use low dose. ZMT: dissolve on tongue and swallow without water.
SELECTIVE 5-HT_1B/1D RECEPTOR AGONIST + NON-STEROIDAL ANTI-INFLAMMATORY (NSAID)
sumatriptan (as succinate)	TREXIMET (GlaxoSmithKline)	85mg	Rx	tabs	Children: not recommended. Adults: Swallow whole. 1 tab once; may repeat once after 2 hours; max 2 tabs/day. The safety of treating an average of more than 5 migraines in a 30-day period has not been established.
naproxen sodium	TREXIMET (GlaxoSmithKline)	500mg	Rx	tabs
NOTES
* = contains phenylalanine ** = contains caffeine + = scored tablets † tabs = tablets; caps = capsules; inj = injection; ODT = orally disintegrating tablets; soln = solution; supp = suppositories; IM = intramuscular; IV = intravenous; SC = subcutaneous Not an inclusive list. Please see drug monograph or visit www.eMPR.com. (Rev. 5/2012)

IV Prochlorperazine Effective for Pediatric Primary Intractable Migraine

Debra Hughes May 18, 2012

Intravenous (IV) prochlorperazine is more effective for the acute treatment of refractory migraine in pediatric patients than IV metoclopramide or valproate sodium. Shannon Cherney, MSN, CNP, from the Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and colleagues sought to evaluate the efficacy of various IV pharmacotherapy options for primary intractable headache in children. The results were presented today at the American Pain Society's 31st Annual Scientific Meeting.

Sumatriptan/Naproxen Helpful in Treating Teens' Migraines

May 15, 2012

Treatment with sumatriptan and naproxen sodium (suma/nap) is well tolerated and effective in reducing migraine pain in adolescents.

Indirect Link ID'd Between Pain Catastrophizing, Severity

May 01, 2012

Pain catastrophizing, in particular ruminating about pain, has an indirect effect on clinical pain severity and pain-related interference, through sleep disturbance.

AAN: Migraine Prevalence Up in Celiac Disease, IBD Patients

April 30, 2012

Patients with celiac disease or inflammatory bowel disease (IBD) and those self-classified with gluten sensitivity (GS) have increased prevalence of migraine.

Botox Modestly Improves Chronic Headaches, Migraines

April 25, 2012

Botulinum toxin A provides a modest benefit for patients with chronic migraine headaches and chronic daily headaches, compared with placebo.

FIORICET

Pain & Pyrexia > Migraine and headache

Butalbital 50mg, acetaminophen 325mg, caffeine 40mg; tabs.

MOTRIN MIGRAINE PAIN

Pain & Pyrexia > Migraine and headache

Ibuprofen 200mg; caplets.

Timolol maleate

Pain & Pyrexia > Migraine and headache

Timolol maleate 5mg, 10mg+, 20mg+; tabs; +scored.

TOPAMAX SPRINKLE CAPS

Pain & Pyrexia > Migraine and headache

Topiramate 15mg, 25mg; coated beads in caps.

ZOMIG NASAL SPRAY

Pain & Pyrexia > Migraine and headache

Zolmitriptan 5mg; per spray.

ASTELIN

Respiratory Tract > Rhinitis/rhinorrhea (intranasal products)

Adverse reactions updated.

Updated: 5/8/2012

ATRAPRO ANTIPRURITIC HYDROGEL

Dermatological Disorders > Pruritus and dry skin

Monograph added.

Updated: 4/25/2012

ATRAPRO DERMAL SPRAY

Dermatological Disorders > Pressure/neuropathic ulcers

Monograph added.

Updated: 4/24/2012

B-NEXA

Nutrition > Vitamins/minerals/supplements

Monograph added.

Updated: 4/30/2012

CETAPHIL DERMACONTROL OIL CONTROL FOAM WASH

Dermatological Disorders > Cleansers

Monograph added.

Updated: 5/10/2012

Pain & Pyrexia > Migraine and headache

For other pain relievers see Nonnarcotic and Narcotic analgesics sections. For antiemetics see Nausea section. The pathophysiology of migraine headaches ...
more »

Treatment Update: PediPirox^™-4 Nail Kit (ciclopirox topical solution, 8%)

April 25, 2012

Update on Melanoma Treatment: SYLATRON™ (peg-interferon alfa-2b) for injection, for subcutaneous use

January 23, 2012

Acute Pain Update: SPRIX^® (ketorolac tromethamine) Nasal Spray 15.75 mg per spray

November 29, 2011

Potentially Inappropriate Drugs for the Elderly (Beers List)

May 21, 2012

A list of drugs that may potentially be inappropriate for use in elderly patients due to their side effects. A description of the possible side effects is indicated next to each drug.

Osteoporosis Treatments

May 16, 2012

Osteoporosis treatment chart.

Mood Disorder Treatments

May 16, 2012

Mood disorder treatments for bipolar disorder, major depressive disorder, treatment resistant depression, premenstrual dysphoric disorder, and others.