Diagnosis and Treatment of Headache. Migraine Prophylactic Treatment Algorithm.

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2007 Jan. 72 p. Diagnosis and Treatment of Headache Migraine Prophylactic Treatment Algorithm Patient meets criteria for migraine headache Patients enter this algorithm from box 57 of the Migraine Treatment Algorithm. Prophylactic treatment. Assess factors that may trigger migraine. First-line treatment: *Medication - Beta-blocker. - Tricyclic antidepressants. *Antiepileptic drugs - Divalproex. - Topiramate. - Gabapentin. - Verapamil. *Reinforce education and lifestyle management. *Consider other therapies (biofeedback, relaxation). *Screen for depression and generalized anxiety. A Successful? * Continue treatment for 6-12 months, then reassess. A * 139, 142, 145. Successful? Success as determined by: *Headaches decrease by 50% or more. *An acceptable side effect profile. Try different first-line medication or different drug of same class. A Successful? * Continue treatment for 6-12 months, then reassess Try combination of beta-blockers and tricyclics. A Successful? * Continue treatment for 6-12 months, then reassess Third-line prophylaxis treatment or consultation with headache specialist. A A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.