Table 3 Treatment options in the management of refractory migraine

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