The practitioner treating migraine should remember:
contraceptive measures should be reassessed if a female patient is of child-bearing age
other medication that may trigger headaches, especially vasodilators, should be discontinued
if patients take large amounts of medication to treat headaches then they may not respond to preventative medication because the drugs compete for monoamine- receptor sites; in this instance the former medication should be discontinued
drugs should be taken for 2-3 months to permit true appraisal of effects
start at a low dose - increments should be such that no more than 3 steps are needed to achieve maximal dose
duration of treatment - this is generally 6 months or longer - then the drug is gradually withdrawn after the frequency of headaches diminishes
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