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Rules for Treating Migraine in Stroke Patients - The Stroke Blog
Treating migraines as a physician is one thing, but once a patient has had a stroke, the ground rules for managing pain in this population change dramatically. One of the challenges a neurologist faces is that many of the tools in the medication arsenal to use against migraines suddenly become contraindicated, or not able to be used, because the risks posed by the medication outweigh the benefits that can be gained from taking them. Here are nine of my personal rules for treating migraines in patients who have survived stroke: Rule #1 – Avoid triptans. Triptans became game changers in the management of migraine when sumatriptan (Imitrex) became available in 1991. Many patients who experienced migraines prior to the sumatriptan era have recounted to me the misery they faced routinely in not having an effective tool to abort migraines without extreme sedation as a side effect of the medications that they were taking. Over time, other triptans were developed – rizatriptan (Maxalt), frovatriptan (Frova), eletriptan (Relpax), and then the injectable triptans, such as injectable sumatriptan. While triptans do not benefit all migraine patients (are migraines ever truly alike between different individuals, or is migraine the final common manifestation of many varying pathways?), millions of people …