- With most patients, we utilize one prevention medication at a time, in low doses, slowly raising the dose as needed. Most of the patients appreciate the approach, and are perfectly willing to wait for the medication to work.
- At times, patients may become extremely frustrated with the headaches, and they desire quick results. When these patients suffer from moderate or severe CDH, with bothersome migraines, it is justified to push ahead at a faster rate with a preventive approach. For instance, amitriptyline and verapamil, or amitriptyline and propranolol may be initiated at the same time. Alternatively, doses may be increased very quickly. The IV DHE repetitive protocol may be utilized, with one or two preventive medications instituted concurrently. The initial amount of preventive medication utilized for a patient depends upon the severity of the headaches and the frustration level of the patient.
- Patients with new onset of severe headaches, which are usually daily headaches plus migraine, are often extremely upset and frustrated with the pain. In this situation, pushing preventive medication at a faster pace is justified.