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We accept referrals for any headache disorder (fax: 1.613.562.6384).
We will not decline referrals. Please understand that we triage referrals according to urgency; provide as much information as you deem is needed to help us triage accordingly.
Patients with established diagnoses who have not had any trials of acute or preventative medications may experience a longer wait time as we try to prioritize care for those patients who have not responded to therapy at the primary care level. Refer to Migraine Canada for a list of acute and preventive medications, the Canadian Headache Society guidelines on preventives, or use our abbreviated guide below as a starting point.
To meet unmet care needs we have organized the following Programs/Streams in our clinic; please indicate if you wish to refer your patient to one of these programs:
Migraine refractory to treatment (e.g., failure of multiple preventives)
Headache in pregnancy, pregnancy-planning, peri-partum, or lactation
Cluster headache and trigeminal autonomic cephalalgias
Spontaneous intracranial hypotension and CSF-leak disorders
Headache in patients with vascular disorders
Optional: feel free to use the sample referral form below should it be helpful to you.
Migraine Acute Medication Options
Migraine Acute Medication Options
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
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.
Ubrogepant 100 mg orally daily as needed, may repeat once 2 hours later
Rimegepant 75 mg orally daily as needed
Migraine Preventive Options
Migraine Preventive Options
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
What do I do if my patient does not respond to an oral preventive medication?
What do I do if my patient does not respond to an oral preventive medication?
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
REFERRAL FORMS (OPTIONAL)
OHC Referral Form.pdfGENERIC REFERRAL FORM
GENERIC REFERRAL FORM
Headache and Pregnancy Clinic Referral Form_260113_133146.pdfHEADACHE IN PREGNANCY PROGRAM
HEADACHE IN PREGNANCY PROGRAM
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