Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of headache. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jan. 70 p. Diagnosis and Treatment of Headache Migraine Prophylactic Treatment Algorithm 143 Patients enter this algorithm from box 57 of the Migraine Treatment Algorithm. Patient meets criteria for migraine headache 144 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 145 146 yes Successful? * Continue treatment for 6-12 months, then reassess A * 145, 148, 151. Successful? Success as determined by: • Headaches decrease by 50% or more • An acceptable side effect profile no 147 Try different first-line medication or different drug of same class A 148 149 Successful? * yes Continue treatment for 6-12 months, then reassess yes Continue treatment for 6-12 months, then reassess no 150 Try combination of beta-blockers and tricyclics A 151 Successful? * 152 no 153 Third-line prophylaxis treatment or consultation with headache specialist A A = Annotation All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.
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