Jump to content

Management of migraine

From Wikipedia, the free encyclopedia

Migraine may be treated either prophylactically (preventive) or abortively (rescue) for acute attacks.[1] Migraine is a complex condition; there are various preventive treatments which disrupt different links in the chain of events that occur during a migraine attack. Rescue treatments also target and disrupt different processes occurring during migraine.

Preventive treatment

[edit]
Main article: Prevention of migraine attacks

Because of the complexity of migraine, no preventive treatment modality is effective for all migraine sufferers.[2] For example, lifestyle (including trigger avoidance), diet changes, diet supplements, and treating conditions such as sleep apnea may all help prevent migraines. Dental appliances such as the Nociceptive Trigeminal Inhibition Tension Suppression System might be used in specific circumstances. Preventive treatments can be sub-divided into non-drug treatments, and treatment with medication. There are several non drug treatments suggested in the literature including weight control, management of migraine comorbidities, lifestyle modification, behavioural treatment and biofeedback, patient education, using headache diaries, and improving patients' knowledge about the disease.[3]

Rescue (or abortive) treatment

[edit]

Rescue treatment involves acute symptomatic control with medication.[4] Recommendations for rescue therapy of migraine include: (1) migraine-specific agents such as triptans, CGRP antagonists, or ditans for patients with severe headaches or for headaches that respond poorly to analgesics, (2) non-oral (typically nasal or injection) route of administration for patients with vomiting, (3)  avoid medication overuse headache by educating patients using prophylactic therapies.[5] Medications are more effective if used earlier in an attack.[4]

The frequent use of medication may result in medication overuse headache (MOH), in which the headaches become more severe and more frequent.[6] This may occur with triptans, ergotamines, and analgesics, especially opioids or narcotic analgesics.[6][7] Combination of opioids with other analgesics is thought to nearly double the risk of MOH.[8]

Spinal manipulation for treating an ongoing migraine headache is not supported by evidence.[9]

Ditans

[edit]

Ditans are a class of abortive medication for the treatment of migraines.[10] Oral lasmiditan (Reyvow) is approved in the US by the FDA for acute treatment of migraine in adults.[11]

Analgesics

[edit]

Recommended initial treatment for those with mild to moderate symptoms are simple analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or the combination of acetaminophen (paracetamol), acetylsalicylic acid (aspirin), and caffeine, although caffeine overuse can be a contributor to migraine chronification as well as a migraine trigger for many patients.[12][13] Aspirin (900 to 1000 mg) can relieve moderate to severe migraine pain, with an effectiveness similar to sumatriptan.[14][15] Paracetamol, either alone or in combination with metoclopramide (an anti-nausea drug), is an effective treatment with a low risk of adverse effects.[16][17] In pregnancy, paracetamol and metoclopramide are deemed safe as are NSAIDs until the third trimester.[12] Intravenous metoclopramide is also effective by itself.[18][19]

Several NSAIDs, including diclofenac and ibuprofen, have evidence to support their use.[20][21] Ibuprofen provides effective pain relief in about 50%.[22] Diclofenac has been found effective. Ketorolac is available in intravenous and intramuscular formulation.[12] The two main adverse drug reactions (ADRs) associated with NSAIDs relate to gastrointestinal (GI) effects and renal effects of the agents.Naproxen by itself may not be effective as a stand-alone medicine to stop a migraine headache as it is only weakly better than a placebo medication in clinical trials.[23]

Triptans

[edit]

Triptans such as sumatriptan are effective for both pain and nausea in up to 75% of migraineurs.[24][25][26] They are the initially recommended treatments for those with moderate to severe pain or those with milder symptoms who do not respond to simple analgesics.[12] The different forms available include oral, injectable, nasal spray, rectal, and oral dissolving tablets.[27][28][29][30] For people with migraine symptoms such as nausea or vomiting, taking the abortive medicine by mouth or through the nose may be difficult. All route of administration have been shown to be effective at reducing migraine symptoms, however, nasal and injectable subcutaneous administration may result in more side effects.[30][29] The adverse effects associated with rectal administration have not been well studied.[28] In general, all the triptans appear equally effective, with similar side effects. However, individuals may respond better to specific ones.[12]

Most side effects are mild, including flushing; however, rare cases of myocardial ischemia have occurred.[27] They are thus not recommended for people with cardiovascular disease,[12] who have had a stroke, or have migraines that are accompanied by neurological problems.[31] In addition, triptans should be prescribed with caution for those with risk factors for vascular disease. While historically not recommended in those with basilar migraines there is no specific evidence of harm from their use in this population to support this caution.[32] Triptans are not addictive, but may cause medication overuse headaches if used more than 10 days per month.[33][34]

Sumatriptan does not prevent other migraine headaches from starting in the future.[29] For increased effectiveness at stopping migraine symptoms, a combined therapy that includes sumatriptan and naproxen may be suggested.[35]

Ergots

[edit]

Ergotamine and dihydroergotamine are older medications still prescribed for migraines, the latter in nasal spray and injectable forms.[27][36] They appear equally effective to the triptans,[37][38] are less expensive,[39][38] and experience adverse effects that typically are benign.[40][41] In the most debilitating cases, such as those with status migrainosus, they appear to be the most effective treatment option.[40][41] The most common adverse effects are nausea, vomiting, abdominal pain, generalized weakness, tiredness, malaise, paresthesia, coldness, muscle pains, diarrhea, and chest tightness. These are less common with DHE than with ergotamine tartrate.[42] Ergots can cause vasospasm including coronary vasospasm, and are contraindicated in people with coronary artery disease.[43]

Phenothiazines

[edit]

Phenothiazines, often used for the treatment of nausea and vomiting, are also effective for treating migraine headache.[44][45] Prochlorperazine is typically used due to a more favorable treatment profile.[46]

Gepants

[edit]

Gepants may be used for rescue as well as prevention. Some gepants are approved for different purposes in different jurisdictions. Zavegepant was approved for medical use in the United States in March 2023.[47][48][49]

Antiemetics

[edit]

Metoclopramide is a recommended treatment for those who present to the emergency department.[12]

Other Medications

[edit]

Intravenous metoclopramide, intravenous prochlorperazine, or intranasal lidocaine are other potential options.[12][19] Metoclopramide or prochlorperazine are the recommended treatment for those who present to the emergency department.[12][19] Haloperidol may also be useful in this group.[19][36] A single dose of intravenous dexamethasone, when added to standard treatment of a migraine attack, is associated with a 26% decrease in headache recurrence in the following 72 hours.[50][51] Spinal manipulation for treating an ongoing migraine headache is not supported by evidence.[52] It is recommended that opioids and barbiturates not be used due to questionable efficacy, addictive potential, and the risk of rebound headache.[12][53] There is tentative evidence that propofol may be useful if other measures are not effective.[54]

Magnesium is recognized as an inexpensive, over-the-counter supplement which can be part of a multimodal approach to migraine reduction. Some studies have shown to be effective in both preventing and treating migraine in intravenous form.[55] The intravenous form reduces attacks as measured in approximately 15–45 minutes, 120 minutes, and 24-hour time periods, magnesium taken orally alleviates the frequency and intensity of migraines.[56][57]

Migraine Treatment for Children

[edit]

For children, ibuprofen or other NSAIDs help decrease pain.[58][59] Triptans are effective, though there is a risk of side effects such as nausea, coronary vasoconstriction, dizziness, paresthesia, flushing, tingling, neck pain, and chest tightness, known as "triptan sensations".[60]

Other Interventions

[edit]

Occipital nerve stimulation, may be effective but has the downsides of being cost-expensive and has a significant amount of complications.[61]

There is modest evidence for the effectiveness of non-invasive neuromodulatory devices, behavioral therapies and acupuncture in the treatment of migraine headaches.[53] There is little to no evidence for the effectiveness of physical therapy, chiropractic manipulation and dietary approaches to the treatment of migraine headaches.[53] Behavioral treatment of migraine headaches may be helpful for those who may not be able to take medications (for example pregnant women).[53]

References

[edit]
  1. ^ "Migraine Headache Treatment & Management: Approach Considerations, Emergency Department Considerations, Reduction of Migraine Triggers". EMedicine Medscape. 2023-06-13.
  2. ^ Silberstein SD (August 8, 2015). "Preventive Migraine Treatment". Continuum: Lifelong Learning in Neurology. 21 (4 Headache): 973–989. doi:10.1212/CON.0000000000000199. ISSN 1080-2371. PMC 4640499. PMID 26252585.
  3. ^ Haghdoost F, Togha M (2022-01-01). "Migraine management: Non-pharmacological points for patients and health care professionals". Open Medicine. 17 (1): 1869–1882. doi:10.1515/med-2022-0598. ISSN 2391-5463. PMC 9691984. PMID 36475060.
  4. ^ a b Bartleson JD, Cutrer FM (2010). "Migraine update. Diagnosis and treatment". Minn Med. 93 (5): 36–41. PMID 20572569.
  5. ^ Ashina M, Buse DC, Ashina H, Pozo-Rosich P (2021). "Migraine: Integrated approaches to clinical management and emerging treatments". Lancet. 397 (10283): 1505–1518. doi:10.1016/S0140-6736(20)32342-4. PMID 33773612.
  6. ^ a b Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia. 24 (Suppl 1): 9–160. doi:10.1111/j.1468-2982.2004.00653.x. PMID 14979299. S2CID 208215944. as PDF Archived 2010-03-31 at the Wayback Machine
  7. ^ Derry CJ, Derry S, Moore RA (2012). "Sumatriptan (oral route of administration) for acute migraine attacks in adults". Reviews. 2012 (2): CD008615. doi:10.1002/14651858.CD008615.pub2. PMC 4167868. PMID 22336849.
  8. ^ Fischer MA, Jan A (2023-08-22), "Medication-Overuse Headache", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30844177, retrieved 2024-05-03
  9. ^ Posadzki P, Ernst, E (June 2011). "Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials". Cephalalgia. 31 (8): 964–70. doi:10.1177/0333102411405226. PMID 21511952. S2CID 31205541.
  10. ^ Qubty W, Patniyot I (2020). "Migraine Pathophysiology". Headache. 107: 1–6. doi:10.1016/j.pediatrneurol.2019.12.014. PMID 32192818. S2CID 213191464.
  11. ^ Lamb YN (2019). "Lasmiditan: First Approval". Drugs. 79 (18): 1989–1996. doi:10.1007/s40265-019-01225-7. PMID 31749059.
  12. ^ a b c d e f g h i j Gilmore B, Michael, M (2011-02-01). "Treatment of acute migraine headache". American Family Physician. 83 (3): 271–80. PMID 21302868.
  13. ^ Nowaczewska M, Wiciński M, Kaźmierczak W (July 2020). "The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment". Nutrients. 12 (8): 2259. doi:10.3390/nu12082259. PMC 7468766. PMID 32731623.
  14. ^ Kirthi V, Derry S, Moore RA (2013-04-30). "Aspirin with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008041. doi:10.1002/14651858.CD008041.pub3. ISSN 1469-493X. PMC 4163048. PMID 23633350.
  15. ^ Kirthi V, Derry S, Moore RA (April 2013). "Aspirin with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008041. doi:10.1002/14651858.CD008041.pub3. PMC 4163048. PMID 23633350.
  16. ^ Derry S, Moore RA (2013-04-30). "Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2013 (4): CD008040. doi:10.1002/14651858.CD008040.pub3. ISSN 1469-493X. PMC 4161111. PMID 23633349.
  17. ^ Derry S, Moore RA (April 2013). "Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008040. doi:10.1002/14651858.CD008040.pub3. PMC 4161111. PMID 23633349.
  18. ^ Eken C (March 2015). "Critical reappraisal of intravenous metoclopramide in migraine attack: a systematic review and meta-analysis". The American Journal of Emergency Medicine. 33 (3): 331–7. doi:10.1016/j.ajem.2014.11.013. PMID 25579820.
  19. ^ a b c d Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE, et al. (June 2016). "Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies". Headache. 56 (6): 911–40. doi:10.1111/head.12835. PMID 27300483.
  20. ^ Rabbie R, Derry S, Moore RA (April 2013). "Ibuprofen with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008039. doi:10.1002/14651858.CD008039.pub3. PMC 4161114. PMID 23633348.
  21. ^ Derry S, Rabbie R, Moore RA (April 2013). "Diclofenac with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008783. doi:10.1002/14651858.CD008783.pub3. PMC 4164457. PMID 23633360.
  22. ^ Rabbie R, Derry S, Moore RA (2013-04-30). "Ibuprofen with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2019 (4): CD008039. doi:10.1002/14651858.CD008039.pub3. ISSN 1469-493X. PMC 4161114. PMID 23633348.
  23. ^ Law S, Derry S, Moore RA (October 2013). "Naproxen with or without an antiemetic for acute migraine headaches in adults". The Cochrane Database of Systematic Reviews. 2013 (10): CD009455. doi:10.1002/14651858.CD009455.pub2. PMC 6540401. PMID 24142263.
  24. ^ Johnston MM, Rapoport AM (August 2010). "Triptans for the management of migraine". Drugs. 70 (12): 1505–18. doi:10.2165/11537990-000000000-00000. PMID 20687618. S2CID 41613179.
  25. ^ Singh RB, VanderPluym JH, Morrow AS, Urtecho M, Nayfeh T, Roldan VD, et al. (December 2020). Acute Treatments for Episodic Migraine. AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID 33411427. Bookshelf ID: NBK566246. Archived from the original on 15 January 2021. Retrieved 28 June 2021.
  26. ^ Johnston MM, Rapoport AM (August 2010). "Triptans for the management of migraine". Drugs. 70 (12): 1505–1518. doi:10.2165/11537990-000000000-00000. PMID 20687618. S2CID 41613179.
  27. ^ a b c Bartleson JD, Cutrer FM (May 2010). "Migraine update. Diagnosis and treatment". Minnesota Medicine. 93 (5): 36–41. PMID 20572569.
  28. ^ a b Derry CJ, Derry S, Moore RA (February 2012). "Sumatriptan (rectal route of administration) for acute migraine attacks in adults". The Cochrane Database of Systematic Reviews. 2012 (2): CD009664. doi:10.1002/14651858.CD009664. PMC 4170908. PMID 22336868.
  29. ^ a b c Derry CJ, Derry S, Moore RA (February 2012). "Sumatriptan (intranasal route of administration) for acute migraine attacks in adults". The Cochrane Database of Systematic Reviews. 2012 (2): CD009663. doi:10.1002/14651858.CD009663. PMC 4164476. PMID 22336867.
  30. ^ a b Derry CJ, Derry S, Moore RA (February 2012). "Sumatriptan (subcutaneous route of administration) for acute migraine attacks in adults". The Cochrane Database of Systematic Reviews. 2012 (2): CD009665. doi:10.1002/14651858.CD009665. PMC 4164380. PMID 22336869.
  31. ^ "Generic migraine drug could relieve your pain and save you money". Best Buy Drugs. Consumer Reports. Archived from the original on 4 August 2013.
  32. ^ Kaniecki RG (June 2009). "Basilar-type migraine". Current Pain and Headache Reports. 13 (3): 217–20. doi:10.1007/s11916-009-0036-7. PMID 19457282. S2CID 22242504.
  33. ^ Tepper SJ, Tepper DE (April 2010). "Breaking the cycle of medication overuse headache". Cleveland Clinic Journal of Medicine. 77 (4): 236–42. doi:10.3949/ccjm.77a.09147. PMID 20360117. S2CID 36333666.
  34. ^ Tepper Stewart J SJ, Tepper DE (April 2010). "Breaking the cycle of medication overuse headache". Cleveland Clinic Journal of Medicine. 77 (4): 236–42. doi:10.3949/ccjm.77a.09147. PMID 20360117. S2CID 36333666.
  35. ^ Law S, Derry S, Moore RA (April 2016). "Sumatriptan plus naproxen for the treatment of acute migraine attacks in adults". The Cochrane Database of Systematic Reviews. 4 (4): CD008541. doi:10.1002/14651858.CD008541.pub3. PMC 6485397. PMID 27096438.
  36. ^ a b Sumamo Schellenberg E, Dryden DM, Pasichnyk D, Ha C, Vandermeer B, Friedman BW, et al. (November 2012). "Acute Migraine Treatment in Emergency Settings". AHRQ Comparative Effectiveness Reviews. Rockville (MD): Agency for Healthcare Research and Quality (US). PMID 23304741. Report No.: 12(13)-EHC142-EF. Archived from the original on 23 August 2023. Retrieved 28 July 2023.
  37. ^ Kelley NE, Tepper, DE (January 2012). "Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium". Headache. 52 (1): 114–28. doi:10.1111/j.1526-4610.2011.02062.x. PMID 22211870. S2CID 45767513.
  38. ^ a b Kelley NE, Tepper DE (January 2012). "Rescue therapy for acute migraine, part 1: triptans, dihydroergotamine, and magnesium". Headache. 52 (1): 114–28. doi:10.1111/j.1526-4610.2011.02062.x. PMID 22211870. S2CID 45767513.
  39. ^ Olesen J (2006). The headaches (3. ed.). Philadelphia: Lippincott Williams & Wilkins. p. 516. ISBN 9780781754002.
  40. ^ a b Morren JA, Galvez-Jimenez, N (December 2010). "Where is dihydroergotamine mesylate in the changing landscape of migraine therapy?". Expert Opinion on Pharmacotherapy. 11 (18): 3085–93. doi:10.1517/14656566.2010.533839. PMID 21080856. S2CID 44639896.
  41. ^ a b Morren JA, Galvez-Jimenez N (December 2010). "Where is dihydroergotamine mesylate in the changing landscape of migraine therapy?". Expert Opinion on Pharmacotherapy. 11 (18): 3085–93. doi:10.1517/14656566.2010.533839. PMID 21080856. S2CID 44639896.
  42. ^ Silberstein SD, Young WB (1995). "Safety and efficacy of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainosus. Working Panel of the Headache and Facial Pain Section of the American Academy of Neurology". Neurology. 45 (3 Pt 1): 577–84. doi:10.1212/wnl.45.3.577. PMID 7898722. S2CID 72696344.
  43. ^ Tfelt-Hansen P, Saxena PR, Dahlöf C, Pascual J, Láinez M, Henry P, et al. (January 2000). "Ergotamine in the acute treatment of migraine: a review and European consensus". Brain. 123 (Pt 1): 9–18. doi:10.1093/brain/123.1.9. PMID 10611116.
  44. ^ AM K, Al E (June 4, 2019). "The Relative Efficacy of Phenothiazines for the Treatment of Acute Migraine: A Meta-Analysis". Headache. 49 (9): 1324–32. doi:10.1111/j.1526-4610.2009.01465.x. PMID 19496829. S2CID 23072214.
  45. ^ BW F (April 20, 2010). "Review: Phenothiazines relieve acute migraine headaches in the ED and are better than other active agents for some outcomes". Annals of Internal Medicine. 152 (8): JC4-11. doi:10.7326/0003-4819-152-8-201004200-02011. PMID 20404368. S2CID 34078516.
  46. ^ Callan JE, Kostic MA, Bachrach EA, Rieg TS (Oct 2008). "Prochlorperazine vs. promethazine for headache treatment in the emergency department: a randomized controlled trial". J Emerg Med. 35 (3): 247–53. doi:10.1016/j.jemermed.2007.09.047. PMID 18534808.
  47. ^ "Zavzpret- zavegepant spray". DailyMed. 9 March 2023. Archived from the original on 25 August 2023. Retrieved 25 August 2023.
  48. ^ "Drug Approval Package: Zavzpret". U.S. Food and Drug Administration (FDA). 3 April 2023. Archived from the original on 25 August 2023. Retrieved 25 August 2023.
  49. ^ "Pfizer's Zavzpret (zavegepant) Migraine Nasal Spray Receives FDA Approval" (Press release). Pfizer. 10 March 2023. Archived from the original on 8 April 2023. Retrieved 10 March 2023 – via businesswire.com.
  50. ^ Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, et al. (June 2008). "Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence". BMJ. 336 (7657): 1359–1361. doi:10.1136/bmj.39566.806725.BE. PMC 2427093. PMID 18541610.
  51. ^ Colman I, Friedman BW, Brown MD, Innes GD, Grafstein E, Roberts TE, et al. (June 2008). "Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomized controlled trials for preventing recurrence". BMJ. 336 (7657): 1359–61. doi:10.1136/bmj.39566.806725.BE. PMC 2427093. PMID 18541610.
  52. ^ Posadzki P, Ernst E (June 2011). "Spinal manipulations for the treatment of migraine: a systematic review of randomized clinical trials". Cephalalgia. 31 (8): 964–70. doi:10.1177/0333102411405226. PMID 21511952. S2CID 31205541.
  53. ^ a b c d Ashina M (November 2020). "Migraine". The New England Journal of Medicine. 383 (19): 1866–1876. doi:10.1056/NEJMra1915327. PMID 33211930. S2CID 227078662.
  54. ^ Piatka C, Beckett RD (February 2020). "Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review". Academic Emergency Medicine. 27 (2): 148–160. doi:10.1111/acem.13870. PMID 31621134.
  55. ^ Yablon LA, Mauskop A (2011). "Magnesium in headache". In Vink R, Nechifor M (eds.). Magnesium in the Central Nervous System. Adelaide (AU): University of Adelaide Press. ISBN 978-0-9870730-5-1. PMID 29920023. Bookshelf ID: NBK507271. Archived from the original on 14 August 2020. Retrieved 19 August 2020.
  56. ^ Chiu HY, Yeh TH, Huang YC, Chen PY (January 2016). "Effects of Intravenous and Oral Magnesium on Reducing Migraine: A Meta-analysis of Randomized Controlled Trials". Pain Physician. 19 (1): E97-112. PMID 26752497.
  57. ^ Veronese N, Demurtas J, Pesolillo G, Celotto S, Barnini T, Calusi G, et al. (February 2020). "Magnesium and health outcomes: an umbrella review of systematic reviews and meta-analyses of observational and intervention studies". European Journal of Nutrition. 59 (1): 263–272. doi:10.1007/s00394-019-01905-w. hdl:10447/360041. PMID 30684032. S2CID 59275463. Archived from the original on 3 February 2023. Retrieved 22 December 2022.
  58. ^ Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, et al. (September 2019). "Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society". Neurology. 93 (11): 487–499. doi:10.1212/WNL.0000000000008095. PMID 31413171.
  59. ^ Gibler RC, Knestrick KE, Reidy BL, Lax DN, Powers SW (2022-09-09). "Management of Chronic Migraine in Children and Adolescents: Where are We in 2022?". Pediatric Health, Medicine and Therapeutics. 13: 309–323. doi:10.2147/PHMT.S334744. PMC 9470380. PMID 36110896.
  60. ^ Nicolas S, Nicolas D (2023-03-07), "Triptans", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32119394, retrieved 2024-05-03
  61. ^ Vukovic Cvetkovic V, Jensen RH (January 2019). "Neurostimulation for the treatment of chronic migraine and cluster headache". Acta Neurologica Scandinavica. 139 (1): 4–17. doi:10.1111/ane.13034. PMID 30291633. S2CID 52923061.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Management_of_migraine&oldid=1252318170"