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Treatment of Headache Following Triptan Failure After Successful Triptan Therapy

  • Headache (JR Couch, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Triptans should remain the first choice in migraine abortive treatment. They are not always effective or adequate for specific patients. Before declaring a triptan in appropriate for a given patient, the provider ought to be analytical about the rationale and especially the use of objective efficacy outcome measures and ensure that treatment is prescribed and used appropriately. Other ergot derivatives, especially dihydroergotamine, may on one hand share common contraindications of triptans but on the other hand can be quite effective where triptans failed. Non-steroids are simple, readily available, and overall safe, and evidence for their efficacy in migraine is plentiful. Opioid analgesics are blatantly overprescribed especially in non-complicated migraine patients. These should be used with great care and restraint and closely monitored. Frequent opioid usage often leads to tolerance, dependence, and medication overuse headache. Neurostimulation is gaining momentum in the armamentarium of migraine management but at the present time remains primarily focused on prophylaxis, yet abortive use is expected to grow.

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References and Recommended Reading

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Conflict of Interest

Marc E. P. Lenaerts and James R. Couch declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

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Authors and Affiliations

  1. Department of Neurology, University of California, Davis, CA, USA

    Marc E. P. Lenaerts MD, FAHS

  2. 4860, Y St, Suite #100, Sacramento, CA, 95817, USA

    Marc E. P. Lenaerts MD, FAHS

  3. Department of Neurology, University of Oklahoma, Norman, OK, USA

    James R. Couch Jr MD, PhD

Authors
  1. Marc E. P. Lenaerts MD, FAHS
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  2. James R. Couch Jr MD, PhD
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Correspondence to Marc E. P. Lenaerts MD, FAHS.

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This article is part of the Topical Collection on Headache

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Lenaerts, M.E.P., Couch, J.R. Treatment of Headache Following Triptan Failure After Successful Triptan Therapy. Curr Treat Options Neurol 17, 27 (2015). https://doi.org/10.1007/s11940-015-0353-6

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  • DOI: https://doi.org/10.1007/s11940-015-0353-6

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