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afya Migraine

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20160425222518 Ben  
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''Mx''
5HT agonists for acute Rx - Zolmitriptan
5HT antagonists for prophylaxis - Topiramate or Propranolol (better for women)

''Acute'' - oral triptan plus NSAID or PCM
if teenager - nasal triptan
if needed add in non-oral metoclopramide (beware acute dystonia in young) or prochlorperazine +/- non-oral NSAID or triptan

''Prophylaxis''
If 2 or more per month 
effective in 60%
Topiramate or propranolol (better in child bearing age women as topiramate is ?teratogenic)
2nd line acupuncture (10 sessions over 5-8/52) or gabapentin
Riboflavin (400mg od) may be helpful
predictable menstrual migraine - use frovatriptan (2.5mg bd) or zolmitriptan (2.5mg bd/tds)
Pizotifen - avoid (wt gain and drowsy)

COCP is CI