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Neuralgia Pain selecting Carbamazepine / Migraine selecting NSAIDs, Triptans / Tension Headache selecting NSAIDs, Acetaminophen

Condition

Treatment

Prophylaxis

Migraine

NSAIDs, Triptans

Propranolol

Tension Headache

NSAIDs, Acetaminophen

Amitriptyline

Neuralgia Pain

Carbamazepine

Gabapentin, Pregabalin

Migraine Management

1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

  • Indication: Effective for mild to moderate migraine attacks.

  • Common choices: Ibuprofen (400-600 mg orally, every 4-6 hours as needed) and Naproxen (500 mg initially, followed by 250 mg every 6-8 hours as needed).

  • Note: Use at the onset of migraine symptoms for best effectiveness.

2. Acetaminophen

  • Indication: An alternative for patients who cannot take NSAIDs, for mild to moderate migraine.

  • Dosage: 500-1000 mg orally every 4-6 hours as needed, not exceeding 3,000 mg per day to avoid liver damage.

3. Triptans

  • Indication: First-line treatment for moderate to severe migraine attacks or for those not responding to NSAIDs.

  • Common choices: Sumatriptan (25-100 mg orally once, may repeat after 2 hours if needed, max 200 mg/day), Zolmitriptan (2.5-5 mg orally, may repeat after 2 hours if needed, max 10 mg/day).

  • Note: Contraindicated in patients with cardiovascular diseases.

Tension Headache Management

1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

  • Indication: Effective for mild to moderate migraine attacks.

  • Common choices: Ibuprofen (400-600 mg orally, every 4-6 hours as needed) and Naproxen (500 mg initially, followed by 250 mg every 6-8 hours as needed).

  • Note: Use at the onset of migraine symptoms for best effectiveness.

2. Acetaminophen

  • Indication: An alternative for patients who cannot take NSAIDs, for mild to moderate migraine.

  • Dosage: 500-1000 mg orally every 4-6 hours as needed, not exceeding 3,000 mg per day to avoid liver damage.

Neuralgia Pain Management

Carbamazepine

  • Indication: First-line treatment for trigeminal neuralgia.

  • Dosage: Starting at 100 mg twice a day orally, gradually increasing to a maintenance dose of 400-800 mg/day divided into 2-4 doses. The maximum dose can go up to 1,200 mg/day based on response and tolerability.

  • Note: Monitor for side effects like dizziness, drowsiness, and blood dyscrasias.

Additional Treatment Options

For Migraine

  • Prophylactic treatment: Considered for patients with frequent, long-lasting, or particularly severe migraine attacks. Beta-blockers (e.g., propranolol), calcium channel blockers (e.g., verapamil), and antiepileptic drugs (e.g., topiramate) are options.

  • CGRP antagonists: Erenumab, Galcanezumab, and Fremanezumab for preventive treatment.

For Tension Headache

  • Muscle relaxants: Occasionally used for managing chronic tension headaches.

  • Antidepressants: Amitriptyline for prevention in chronic cases.

For Neuralgia Pain

  • Other anticonvulsants: Pregabalin and gabapentin may be considered if carbamazepine is not effective or not tolerated.

  • Surgical intervention: In cases of trigeminal neuralgia not responsive to medical therapy, microvascular decompression or other surgical procedures might be indicated.

Remember, the choice of medication and dosage should be individualized, considering the patient's medical history, comorbidities, and potential drug interactions. Regular follow-up is crucial to assess efficacy and adjust the treatment plan as needed.

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