rx migaine vs cluster? - ninila

[ArchivalUser]

hi i have yet another question...
what is the protocaol for migraine vs cluster headaches treatment?

1 nasid
2 sumatriptin
3 ergots

what drugs for acute attach and which for prophylaxis?

thanks and good luck!

[ArchivalUser]

MIGRAINE Tx:
-4 mild to moderate headaches (w/o nausea & vomiting) the best tx is NSAIDs. Should be used sparingly coz can caused rebound headaches.
-4 moderate to severe pain attack “ 5HT1b/1d antagonists (sumatriptan, zolmitriptan).
Ergot alkaloid (2nd choice) or metoclopramide can be also used to abort acute attack.
-4 prophylaxis (pt has >1 headache a week) “ beta-blockers, Ca-block, TCA or anticonvulsants.

CLUSTER Tx:
-4 acute attack: 1. 100% O2 therapy by nasal mask, or
2. sumatriptan or ergots. Indomethacin is uniquely effective 4 clusters h.
-4 prophylaxis “ verapamil, methysergide, lithium, prednisone.

Sumtriptan shouldn't be used in pt with history of CAD.

[ArchivalUser]

great thanks mdfriend

[ArchivalUser]

methysergide is not used now because of very fatal side effect of retroperitoneal fibrosis correct me if wrong thanks

[ArchivalUser]

You are right about that serious side effect (good point), but it can be used, at least according to the Merck manual. Definitely not as a 1st or 2nd choice & after 6 moths of tx the drug free interval (or substitution) is required.
Regards!