1. No category

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
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