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Migraine Management Protocol (Philippine Neurologists)

Chronic/Non-Communicable

1. Assessment & Diagnosis

  • Standard: Diagnosis is primarily based on the ICHD-3 Criteria (International Classification of Headache Disorders).
  • Neuroimaging: Cranial CT or MRI is often requested for patients with a long history of recurrent severe migraine (e.g., >3 years) to rule out secondary causes.
  • Triggers: Common triggers include stress, sleep deprivation, and certain foods.

    • 2. Acute Treatment (Abortive)

  • First-Line: NSAIDs (e.g., Naproxen, Ibuprofen) are the most preferred initial treatment for mild to moderate attacks.
  • Second-Line: Triptans (e.g., Zolmitriptan, Sumatriptan) are used for moderate to severe attacks where NSAIDs fail.
  • Adjunct: Anti-nausea medications (Anti-emetics) are recommended for patients experiencing vomiting or severe nausea.

    • 3. Preventive Treatment (Prophylaxis)

  • Indication: Considered for frequent or disabling attacks.
  • Preferred Medications:

    • 1. Topiramate (Anticonvulsant) - Most commonly prescribed.

    2. Beta-Blockers (e.g., Propranolol).

    3. Calcium Channel Blockers (e.g., Flunarizine).

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    Warning Signs

    WHEN TO IMAGE (Rule Out Secondary Causes)

  • Change in pattern: Significant increase in frequency or severity.
  • Neurologic Deficits: Weakness, numbness, or confusion.
  • Persistent Symptoms: Headache failing to respond to standard therapy.

    • Reference

    1. Artemio Agra Roxas Jr MD, et al. (Philippine General Hospital / The Medical City) (2022). The practice patterns of migraine management among neurologists in the Philippines (Neurology Asia).
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