Headache

#

1. Migraine

    1. Treatment:

        1. tab Ibuprofen 400 mg q8-12h #30

        2. or tab diclofenac 50-100 mg q8-12h #30

        3. or Tab naproxen 250 mg q8h #30

        4. tab metoclopramide 10 mg q12h #20 if N/V

        5. if not controlled:

            1. tab sumatriptan 50 mg #20

            2. or Nasal spray sumatriptan 20 mg #1 (for  age 12-17 y/o start with spray 10 mg)

            3. or Amp sumatriptan 6 mg SQ #1

        6. if recurrent:

            1. Tab ergotamine with 1-2 mg #30, 2 tab stat repeat q30min (max 6 tabs)

        7. Combined pills:

            1. tab Treximet (Sumatriptan + naproxen) 85-500 mg q6h #30 for age >12 y/o

            2. Tab Novafen q6h #30

            3. Tab Excedrin q12h #30

    2. Emergency treatment

        1. Amp ketorolac 30 mg IV

        2. Amp metoclopramide 10 mg IV + Amp dexamethasone 4-8 mg IM

    3. Prophylaxis:

        1. Tab propranolol 20 mg q12h #60

        2. or Tab metoprolol 50-100 mg q12h #60

        3. Tab amitriptyline 10 mg qd #60

        4. if not controlled at all ⇒ REFER the PT

            1. Tab Na-valproate 300-1000 mg bid

            2. or Tab Topiramate 25 mg qid or 50 mg bid

2. Tension headache

    1. Treatment:

        1. tab Ibuprofen 400 mg qid #30

        2. or tab Naproxen 250 mg tid #30

        3. or Tab ACA qid #30

        4. or Tab Ergotamine C 1-2 mg #30

    2.  prophylaxis

        1. tab amitriptyline 10-150 mg qd

3. Cluster headache

    1. O2 therapy

    2. Amp sumatriptan 6mg SQ

    3. Discharge the pt with

        1. Tab verapamil 80 mg q8h #40

        2. tan Naproxen 250 mg q8h #30

        3. Tab prednisolone 50 mg #15 taper in 2 weeks

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1. Migraine Headache

    1. treatment

        1. Amp ketorolac 30mg IM

        2. Amp betamethasone IM

        3. Serum N/S 100cc IV

        4. Tab Naproxen 500mg #30 q8h

        5. Tab sumatriptan 50mg #10, 1 pill in headache, 1 pill 2 hrs later if still + headache

            1. or Tab ergotamine-c 1-2mg #30, 2 tabs if headache

    2. Prophylaxis

        1. Tab inderal 20mg  bid

            1. or Tab amitriptyline 10mg qhs

2. Tension headache in pregnancy

    1. Tab acetaminophen 500mg #30 q8h

    2. Amp apotel 1gr in 500cc N/S IV slow infusion

    3. check BP is crucial

3. Red Flags

    1. Trauma specially in last 3 days

    2. decreased LOC

    3. High grade fever

    4. Neurologic deficit

    5. on Narcotics

    6. Worst ever headache

4. If referred the pt, do not prescribe anything

5.