even in non-nauseated patients, and parenteral
administration is usually preferred. Use of
metoclopramide or domperidone 30 min before
analgesics improves oral absorption and combats the
nausea but there is no evidence that analgesic efficacy is
improved. The choice of drug, dose, and route depends
on the characteristics and frequency of the attacks and on
the preferences of and contraindications for the patient.
Not all attacks in a given patient are necessarily treated
with the same drug or dose. Mild attacks may be
managed with analgesics or NSAIDs while severe
disabling ones usually respond better to specific
antimigraine drugs. Previous experience with a drug is
important but the patient’s opinion may be biased
because of previous use of suboptimal doses or routes of
administration. Treatment should begin with the lowest
dose likely to be effective, the dose being increased or the
drug changed after treatment of two or three attacks if
necessary. The maximal tolerated and effective dose
should then be taken in one dose