This protocol applies when a migraine attack with aura has not responded sufficiently to a triptan combined with a non-steroidal anti-inflammatory drug, and escalation to a next-line approach is indicated.
A triptan combined with a long-acting NSAID was given. In cases of inadequate response, the combination with a rapid-acting NSAID may also have been tried. Escalation to this protocol is triggered when two clinical goals remain unmet: pain-free status at 2 hours after administration and prevention of headache recurrence.
This protocol employs parenteral emergency medications given by intravenous or subcutaneous route. The complete structured regimen — including agent selection, combination strategy, and sequencing — is available in the full protocol.
The treatment of first choice is the intravenous administration of 1000 mg ASA with or without metoclopramide.
If there are no contraindications, sumatriptan 6 mg can also be given subcutaneously.
The following drugs can be used for intravenous injections: ASA, metoclopramide (and other dopamine-antagonists), metamizole, sumatriptan and steroids
DOI: 10.1177/2514183X1882337
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