250mg IV to abort an acute attack
Relief lasts from four hours to three days
Fosphenytoin seems to work similarly
First-line agent with 75% success rate initially
Proposed Mechanism: Decreases the response of neurons to peripheral stimulation
Started at 100mg one to two times per day
Increase by 100-200mg every 3 days
Usual maintenance dose is 400-800mg (rare >1500mg)
Metabolized by liver (cytochrome P450)
LFTs monitored on outpatient basis
Pain relief occurs within several hours to days (94% within 48 hours)
Target serum concentration is 24-43 μmol/L
If unsuccessful, phenytoin 200-400mg/day is used in combination
LFTs monitored on outpatient basis
If unsuccessful, phenytoin 200-400mg/day is used in combination
Baclofen, clonazepam, valproic acid, lamotrigine, gabapentin, oxcarbazepine, topiramate
Posterior fossa microvascular decompressive surgery
Approximately 50% of patients will require surgery
Successful in 70% of patients
Approximately 50% of patients will require surgery
Trigeminal neuralgia
Migraine headache
Tension headache
Cluster headache
Meningitis/encephalitis
Post-lumbar puncture headache
Neoplastic meningitis
Heat syncope