Headache Resources and Prescribing Guides for Clinicians

Triptans

Maximum under 10 days per month of use. Various doses are available - this guide is for reference only.

Quick acting oral triptans:

Almotriptan 12.5 mg orally daily as needed, may repeat once 2 hours later

Eletriptan 40 mg orally daily as needed, may repeat once 2 hours later

Rizatriptan 10 mg orally daily as needed, may repeat once 2 hours later

Sumatriptan 100 mg orally daily as needed, may repeat once 2 hours later

Zolmitriptan 5 mg orally daily as needed, may repeat once 2 hours later

Long acting oral triptans:

Frovatriptan 2.5 mg orally daily as needed

Naratriptan 2.5 mg orally daily as needed, may repeat once 4 hours later

Intranasal triptans:

Sumatriptan 20 mg intranasal daily as needed, may repeat once 2 hours later

Zolmitriptan 5 mg intranasal daily as needed, may repeat once 2 hours later

Subcutaneous triptans:

Sumatriptan 6 mg subcutaneously daily as needed, may repeat once 1 hour later

Gepants

Avoid in pregnancy. This is list is for reference only and on-label directions should be followed.

Rimegepant 75 mg orally daily as needed

Ubrogepant 100 mg orally daily as needed, may repeat once 2 hours later

Non-specific oral migraine preventives

This guide is for reference only, please confirm contraindications and side-effects prior to prescribing.

Amitriptyline 10-25 mg orally at night; can be titrated up to 50-100 mg at night

Candesartan 8 mg orally daily; can be titrated up to 32 mg orally daily (avoid in pregnancy)

Metoprolol 25 mg orally twice daily; can be titrated to 50 mg orally twice daily

Propranolol 20 mg orally twice or three times daily; can be titrated up to 80 mg orally three times daily

Topiramate 25 mg orally at night; can be titrated up every 1-2 weeks to 50 mg orally twice daily (avoid in pregnancy)

Venlafaxine 37.5 mg orally daily; can be titrated up to 150 mg orally daily

Migraine-specific oral preventives

Atogepant 60 mg orally daily (avoid in pregnancy; ensure patient meets eligibility and insurance criteria)

Migraine-specific CGRP injectable preventives

Please ensure adequate contraception is used; pregnancy should be avoided within 6 months of use. Ensure patients meet eligibility and insurance criteria.

Eptinezumab 100 or 300 mg intravenously quarterly

Erenumab 70 or 140 mg subcutaneously monthly

Fremanezumab 225 mg subcutaneously monthly or 675 mg subcutaneously quarterly

Galcanezumab 240 mg subcutaneously once followed by 120 mg subcutaneously monthly

If a patient does not have meaningful improvement from an oral preventive after 3 months of use, please consider switching to a second oral preventive of a different class.

Patients should not stay on oral preventives that result in poor side effects.

Ensure patients are not overusing their acute medications, as this can lead to medication overuse headache.

Non-specific oral preventives:

Amitriptyline 10-25 mg orally at night; can be titrated up to 50-100 mg at night

Candesartan 8 mg orally daily; can be titrated up to 32 mg orally daily (avoid in pregnancy)

Metoprolol 25 mg orally twice daily; can be titrated to 50 mg orally twice daily

Propranolol 20 mg orally twice or three times daily; can be titrated up to 80 mg orally three times daily

Topiramate 25 mg orally at night; can be titrated up every 1-2 weeks to 50 mg orally twice daily (avoid in pregnancy)

Venlafaxine 37.5 mg orally daily; can be titrated up to 150 mg orally daily

Feel free to download and use or patient medication handouts.

Canadian Headache Society Primary Care Tip Sheets