Thread by @neudrawlogy

#NeudrawlogyMigraineEdition, part 5! 🤕 🧠

Here goes a review of the preventive treatments for migraine! 🧵 (1/10)

✅ Learn here:
🎯 Indications;
💊 General recommendations about the treatment.

#NeuroTwitterNetwork #NeuroTwitter #FOAMed #MedEd #MedTweetorial

1/❓But first, a question:
A 28-year-old woman with migraine without aura has 2 attacks/month lasting 8h, and her episodes are relieved by NSAIDs. Would you prescribe her a preventive migraine treatment?

2/❓Let’s suppose the same person has hemiplegic migraine with 1 attack/year. Would you treat her?

3/ Ok, now back to the goals.
🎯 Indications for preventive treatments are (1/3):
- Attacks that significantly interfere with patient’s daily routine despite acute treatment
- Ineffective or contraindicated acute migraine treatment

4/ 🎯 Indications for preventive treatments are (2/3):
- >2 severe or disabling attacks or <4 less disabling attacks per month
- Patient preference
- Highly disabling migraine attacks (e.g., hemiplegic migraine, migraine with brainstem aura)

(3/3) Review the aura types below ⬇️

https://twitter.com/neudrawlogy/status/1480544557632794624

5/ Here are some the general recommendations 💊
Some authors suggest initial treatment with any of these 4 drugs since they work in 50% of the patients:
- Amitriptyline
- Propranolol or metoprolol
- Topiramate
- Venlafaxine

6/ Other recommendations are: (1/2)
- 🪫 Start at a low dose
- ⛔🏃‍♀️Do not hurry. Some drugs can take four weeks and some up to 6 months to be effective
- 👨‍🏫👩‍🏫 Set expectations, explain possible side effects 🤢, and 🥅 goals of care

For a great 🧵 about topiramate, see

https://twitter.com/CSWhiteMD/status/1499414703029858318

by @CSWhiteMD

(2/2)

7/ Migraine is a chronic disease. So, treatment may be prolonged.

📅 Some experts suggest at least 6 migraine-free months before attempting to remove the drug.

8/ Now to the quiz, again. Would you treat this patient?
❓A 28-year-old woman with migraine without aura refers 2 attacks/month lasting 8h and her episodes are relieved by NSAIDs use. Would you prescribe her a preventive migraine treatment?

9/ ❓What about this one?
A 28-year-old woman with hemiplegic migraine refers 1 attack/year. Would you treat her?

10/ 🫂Thank you for reading! References below:

📚Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. @ihs_official @JCephalalgia @CephEditorial tinyurl.com/2p9h3ndw

📚Preventive Migraine Treatment @ContinuumAAN tinyurl.com/ywk8f2jf

📚The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. @ahsheadache @HeadacheJournal tinyurl.com/2p9h3ndw

📚Migraine--current understanding and treatment. @NEJM tinyurl.com/2r6kxh6d

If you want to see the other #tweetorials, click here:
docs.google.com/document/d/1oB…