Acute Migraine Medication Issues

This presentation will examine clinical uncertainties in the acute management of migraine, with a focus on the use of NSAIDs in patients on anticoagulation therapy, those with a history of gastrointestinal bleeding, and individuals with cardiovascular risk factors. It will also address the use of triptans and dihydroergotamine (DHE) in patients with contraindications, including risks of serotonin syndrome, hypertension, reversible cerebral vasoconstriction syndrome (RCVS), and hemiplegic migraine. Additionally, the combination of gepants with triptans and CGRP monoclonal antibodies will be discussed. Finally, an approach to tapering opioids and butalbital will be presented.