Table 1. Medications Treatment (Brand) Dose
Acute
Level A Sumatriptan (Alsuma, Imitrex, Sumavel DosePro)
Oxygen
Zolmitriptan (Zomig)
Level B
Sumatriptan (Imitrex)
Zolmitriptan (Zomig)
Level C Cocaine hydrochloride
Lidocaine
Octreotide (Sandostatin)
Preventive Level B
Civamide (zucapsaicin)a
Suboccipital steroid/ local anesthetic injection
Level C Melatonin Transition
Lithium (Eskalith)
Verapamil (Verelan PM Calan Isoptin SR)
10 mg daily oral 360 mg daily oral
900 mg daily oral
Steroids – prednisone 60 mg oral daily for 3 days, then decreased by 10 mg every 3 days for a total of 18 days
Dihydroergotamine (Migranal, D.H.E. 45) 1 mg subcutaneous/
Ergotamine tartrate (Ergomar)
Suboccipital steroid injections
a Not currently available. 3
intramuscular twice a day for several days
1 or 2 mg given once daily or in divided doses
12.46 mg betamethasone dipropionate and 5.26 mg betamethasone disodium phosphate mixed with 0.5 mL Xylocaine 2%
Transient injection site pain 6 mg subcutaneous
100% at 6–12 L/min by nasal cannula
Injection site reactions, nausea and vomiting, dizziness, fatigue, paresthesias
Unpleasant taste, nasal cavity discomfort, somnolence, dizziness, nausea, throat/neck tightness
5 and 10 mg intranasal Paresthesias, heaviness, asthenia, nausea, dizziness, nonchest tightness
20 mg intranasal 5–10 mg oral
10% intranasal 10% intranasal 100 mcg subcutaneous Bitter taste
Paresthesias, heaviness, asthenia, nausea, dizziness, nonchest tightness
Nasal congestion. Concerns regarding drug addiction and availability of medication
Nasal congestion, unpleasant lidocaine taste
Injection site reactions, diarrhea, abdominal bloating, nausea, dull background headache, lethargy
100 microL of 0.025% intranasal
Nasal burning, lacrimation, pharyngitis, rhinorrhea
Transient injection site pain No adverse events
Constipation, reduced blood pressure, reduced heart rate
Polyuria
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