Diagnosis and Treatment of Headache. Migraine Treatment Algorithm.

[Return to Diagnosis Algorithm]

[Refer to the DHE Protocol algorithm]

[Refer to: Menstrual-Associated Migraine algorithm]

[Refer to: Perimenopausal or Menopausal Migraine algorithm]

[Refer to: On Estrogen-Containing Contraceptives or Considering Estrogen-Containing Contraceptives with Migraine Algorithm]

[Refer to the 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 Treatment Algorithm Patient meets criteria for migraine. A The patient would enter this algorithm from box 17 of the Diagnosis Algorithm. Is patient experiencing a typical headache? A Return to Diagnosis Algorithm. Out of guideline. Categorize according to peak severity based on functional impairment, duration of symptoms, and time to peak impairment. A Mild Moderate Severe Status (greater than 72 hour duration). A Mild treatment:** - APAP / ASA / Caffeine. - ASA. - Lidocaine nasal. - Midrin®. - NSAIDs. - 5 HT agonists (triptans) Almotriptan. Eletriptan. Frovatriptan. Naratriptan. Rizatriptan. Sumatriptan. Zolmitriptan. *Adjunctive drug therapy. A Moderate treatment:** - DHE. - Ergotamine tartrate. - Lidocaine nasal. - Midrin® and others. - NSAIDs. - 5 HT agonists (triptans). See treatment in #32. *Adjunctive drug therapy. A Severe - Prochlorperazine. - Chlorpromazine. - DHE. - Ketorolac IM. - Magnesium Sulfate IV. - 5 HT agonists (triptans). See treatment in #32. *Adjunctive drug therapy. Adjunctive therapy. A Patient meets criteria for DHE? A Chlorpromazine valproate sodium IV magnesium sulfate IV or prochlorperazine. A Successful? A Successful? A Successful? Refer to the DHE Protocol algorithm Successful? A Opiates. A Specialty consultation indicated? Successful? Dexamethasone. A Consultation with headache specialist. A Successful? Headache resolved Refer to: *Menstrual-Associated Migraine algorithm Perimenopausal or Menopausal Migraine algorithm On Estrogen-Containing Contraceptives or Considering Estrogen-Containing Contraceptives with Migraine Algorithm Is this a hormone-related migraine? Adjunctive therapy 32, 36, 39, 44 *Rest in quiet, dark room. *IV rehydration. *Antiemetics ** - Hydroxyzine. - Metoclopramide. - Prochlorperazine. - Promethazine. *Caffeine. Is patient candidate for prophylactic treatment? Continue acute treatment Refer to the Migraine Prophylactic Treatment algorithm A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.