What treatment would you recommend for aborting a migraine in a patient with known coronary artery disease (CAD)? — Lori Meadors, PA-C, Houston

First, try nonsteroidal anti-inflammatory drug (NSAID) therapy with ibuprofen 400-1,200 mg or naproxen 750-1,250 mg. Next, add acetaminophen and caffeine concurrently with NSAID therapy (you may want to protect the stomach). If this does not abort migraine, consider triptans.

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Triptans inhibit transmission in the trigeminal nucleus caudalis while promoting vasoconstriction. In the setting of CAD, vasoconstriction can precipitate angina. If CAD is mild, triptans can be used as long as the first dose is monitored in a medical setting. However, triptan therapy would be highly risky with multivessel disease. Educate patients to treat migraines early and aggressively with the prescribed dose regimen. If patients wait too long to treat, GI uptake is delayed and migraine abortion is limited. — Maria Kidner, DNP, FNP-C (159-2)