4.1.3.

MIGRAINE
Treatment guidelines
Management Comments
Non-drug Patients should be Referral criteria
treatment reassured that this is a
benign condition. • Status migrainosus
They should attempt to • No control with
identify food allergies and prophylactic
try to diminish patterns of therapy.
tension. • Focal headache
Health education and focal
neurological signs
which always occur
on the same side,
(a CT scan should
be done to exclude
an aneurism or
arteriovenous
malformation or
mass lesion).
• Sudden onset of a
first severe
headache, even if it
resembles
migraine, in an
older patient, as
this may indicate
serious organic
pathology.
• Progressive
headache with
deteriorating mental
state, especially if
neurological signs
persist with the
headache (e.g.
neck stiffness,
hemiplegia).
• Associated
systemic features
e.g. hypertension,
tachycardia or
pyrexia.

Drug Propranolol, oral, 20 mg/day Regular, daily, prophylactic

treatment in divided doses; titrate therapy is advised if attacks
Prophylaxis: dose up to adequate are frequent or severe i.e
response (seldom requires more than 2–3 per month.
more than 160 mg/day)
OR Success rate: 60–70%
Amitriptyline, oral, 10–25
mg at bedtime, titrate dose
up to adequate response. It
seldom requires more than
75–150 mg as a single
bedtime dose.
Acute Analgesics, e.g. Aspirin, Initiate therapy during the
treatment, mild soluble, 600–900 mg once, attack or at the very onset
attacks: followed by 300 mg half of the headache.
hourly up to a maximum
dose of 1800 mg
OR
Paracetamol, oral, 500–1
000 mg 4–6 hourly,
OFTEN WITH AN
ANTIEMETIC e.g.
Metoclopramide, oral, 10
mg 3 times daily until
headache is relieved.
More severe NSAIDs, e.g. Ibuprofen,
attacks, oral, 600–1 200 mg/day, in
especially with 2–3 divided doses Ergot preparations are
a defined aura: AND/OR contraindicated in
Ergot preparation e.g. peripheral vascular disease.
Ergotamine and caffeine (1
mg/100 mg), 1–2 tablets To be prescribed by a
immediately, followed by ˝– neurologist only
1 tablet every 30 minutes to
a maximum of 4 tablets per
attack or 10 tablets per
week, or until vomiting
occurs.
OR
Dihydroergotamine, IM or
SC, 1–2 mg immediately.
Repeat after 30 minutes if
necessary

© Copyright 1998, The National Department of Health