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Table 3 Treatment options in the management of refractory migraine

From: Identifying and managing refractory migraine: barriers and opportunities?

  Oral/Nasal Injectable Neurostimulation
Acute • Oral and Intranasal Triptans
• High dose NSAIDS
• Paracetamol
• Antiemetics
• Subcutaneous sumatriptan • Transcranial magnetic stimulation
• External trigeminal nerve stimulation (Cefaly)
• Vagal nerve stimulation
Preventive • Beta-blockers: Propranolol, Metoprolol, Timolol, Atenolol, Nadolol
• Anticonvulsants: Topiramate, Valproate
• Tricyclics: Amitriptyline
• SNRI: Venlafaxine
• Angiotensin pathway blockers: Lisinopril, Candesartan
• Calcium channel blockers: Flunarizine
• Nutraceuticals: Riboflavin, Coenzyme Q10, Magnesium, Feverfew
• Onabotulinumtoxin A
• CGRP-pathway monoclonal antibodies
• External trigeminal nerve stimulation (Cefaly)
• Transcranial magnetic stimulation
• Occipital nerve stimulation
• High cervical spinal cord stimulation
Transitional • Corticosteroids • Greater occipital nerve block
• Multiple cranial nerve blocks
• Intravenous dihydroergotamine
• Intravenous lidocaine
  1. NSAIDS Non-steroidal anti-inflammatory drugs