Prevention (3 or more attacks a month): Propranolol, Flunarizine, Amitriptyline, Topiramate (not in pregnancy — needs reliable contraception)
Advice and when to refer
Advice: Pain-killers under 10–15 days a month (overuse headache); headache diary. New headache over 50 y, thunderclap, fever, neuro signs → urgent scan (NICE CG150 2025)
Investigations
First visit
No tests needed — Typical migraine with a normal examination needs no imaging.
Only if indicated
MRI brain — Red flags: new headache over 50, thunderclap, worst ever, neurological signs, fever, cancer or HIV, change in pattern.
ESR / CRP — Over 50 with scalp tenderness or jaw pain (giant cell arteritis).
Fundoscopy — Headache worse lying down or on straining (raised pressure).
Locked
The adult dose for each drug
The child dose, where the card gives one
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.