What is the recommended treatment for migraines occurring 1 week after a dilation and curettage (D&C) procedure?

Treatment for Migraines 1 Week After D&C

For migraines occurring 1 week after a D&C procedure, the recommended first-line treatment is a combination of a triptan (such as sumatriptan) with an NSAID (such as ibuprofen, naproxen, or aspirin) or acetaminophen to maximize efficacy. 1, 2

First-Line Treatment Options

• For mild migraines, consider starting with an NSAID (aspirin, ibuprofen, naproxen, or diclofenac) or the combination of an NSAID with acetaminophen 1, 3
• For moderate to severe migraines, use a triptan (sumatriptan, rizatriptan, naratriptan, or zolmitriptan) combined with an NSAID or acetaminophen for improved efficacy 1, 2, 4
• Begin treatment as early as possible after migraine onset to maximize effectiveness 1, 3
• If using sumatriptan tablets, the recommended dose is 50 mg or 100 mg, with 50 mg often providing sufficient effect while minimizing side effects 5

Treatment Considerations After D&C

• Post-D&C migraines may be triggered by hormonal fluctuations, stress, or anesthesia effects, but the treatment approach remains the same as for typical migraines 2, 3
• For patients with significant nausea or vomiting (which may be more common after a procedure), consider:
  • A non-oral triptan formulation (nasal or injectable) 1, 3
  • Adding an antiemetic such as metoclopramide or prochlorperazine 3

Second-Line Options

• If first-line treatments are ineffective or not tolerated, consider:
  • CGRP antagonists (rimegepant, ubrogepant, or zavegepant) 1, 2
  • Dihydroergotamine (DHE) intranasal or injectable 1, 2
  • Lasmiditan (a ditan) for those who don't respond to other treatments 1

Important Cautions

• Avoid opioids and butalbital-containing medications for migraine treatment, as they can lead to dependency and medication overuse headache 1, 3
• Limit acute treatments to no more than 2-3 days per week to prevent medication overuse headache 2, 3
• Triptans are contraindicated in patients with cardiovascular disease, uncontrolled hypertension, or history of stroke 2
• If a second dose of sumatriptan is needed, wait at least 2 hours after the first dose, and do not exceed 200 mg in a 24-hour period 5

Specific Treatment Algorithm

1. For mild migraine:

   • Start with ibuprofen 400 mg or naproxen sodium 550 mg 1, 6
   • If inadequate relief after 2 hours, add a triptan 1, 2

2. For moderate to severe migraine:

   • Immediately use combination therapy: sumatriptan 50 mg plus naproxen sodium 550 mg 1, 2
   • Clinical trials show this combination provides superior relief compared to either medication alone 5, 7

3. If significant nausea/vomiting is present:

   • Use non-oral route (sumatriptan nasal spray or injection) 3
   • Add metoclopramide 10 mg for antiemetic effect 3

4. If first treatment fails:

   • Try a different triptan if first one was ineffective 1
   • Consider CGRP antagonist or DHE as alternative 1, 2

5. For frequent migraines (>4 per month):

   • Consider preventive treatment in addition to acute therapy 1, 4

Remember to monitor for medication overuse headache, which can develop if acute treatments are used ≥10 days/month for triptans or ≥15 days/month for NSAIDs 1, 2.