Diagnosis and Treatment of Headache. Menstrual-Associated Migraine Algorithm.

[Refer to Estrogen-Containing Contraceptives Migraine 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 Menstrual-Associated Migraine Algorithm The patient would enter this algorithm from box #54 of the Migraine Treatment Algorithm. Patient meets criteria for menstrual-only or menstrual-associated migraine. A Menstrual only *Headache occurs exclusively plus or minus 2 days from onset of menses. Associated but not limited to menstruation. *Occurs greater than 6-8 days/month. OR *Occurs greater than or equal to 3 days/month when optimally treated and still debilitating. A = Annotation Initiate treatment for migraine (algorithm boxes #32, 36, 39) Therapy successful? Continue therapy Consider cyclic prophylaxis *NSAIDs. *Triptans. *Ergots. A Continue therapy Patient improves? Consider hormone prophylaxis: *Transdermal estradiol. *Estrogen-containing contraceptives. *GnRH agonists with "add back" therapy. Refer to Estrogen-Containing Contraceptives Migraine Algorithm Continue therapy Patient improves? Consider consult with headache specialist All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.