# Migraine - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE CG150 Headaches 2021 (recommendation 1.3.11) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) · Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), "Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." - Verified date: 2026-08 ## Verified against - Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) - MSF Essential Drugs 2024 - paracetamol (oral) - Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) - Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) - Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) - Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) - Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) - Migraine Headache - disease-level clinical article (migraine-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), "Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Sumatriptan — 50 mg — oral.solid - Paracetamol — 500 mg — oral.solid - Acetylsalicylic acid — 300 mg — oral.solid - Referral & safety-netting (no drug therapy) - Propranolol — 40 mg — oral.solid - Amitriptyline — 25 mg — oral.solid - Topiramate — 25 mg — oral.solid - Metoclopramide — 10 mg — oral.solid ## Complete treatment card ```text MIGRAINE Sources: Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) · MSF Essential Drugs 2024 - paracetamol (oral) · NICE CG150 Headaches 2021 (recommendation 1.3.11) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) · Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) · Ibuprofen 400 mg film- coated tablets (POM) SmPC section 4.2 (eMC product 7020) · Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), "Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." Review status: REVIEWED against Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683), MSF Essential Drugs 2024 - paracetamol (oral), Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg).", Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph), Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph), Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020), Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524), Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph), Migraine Headache - disease-level clinical article (migraine-clinical.txt), Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), "Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Prodrome symptoms occur up to 24 to 48 hours before the headache in roughly 77% of patients [headache] - Prodrome can bring yawning, mood change, neck stiffness, light or sound sensitivity, food cravings, or thirst [neck stiffness] - Aura is usually gradual, lasts under 60 minutes, and is mostly visual, with both positive and negative features - A shimmering, zigzag-edged area of absent vision (scintillating scotoma) is the most common positive visual aura [scotoma] - The headache itself is usually one-sided and throbbing, worsening over the first hours, lasting hours to days [headache] - Nausea, vomiting, sensitivity to light or sound, a runny nose, tearing, or smell sensitivity can accompany the headache [eye discharge · headache · nausea · photophobia · runny nose · vomiting] - After the headache resolves, patients often report exhaustion, dizziness, poor concentration, or a sense of euphoria [dizziness · fatigue · headache · poor concentration] - Untreated attacks typically last 4 to 72 hours - At least two of one-sided location, throbbing quality, moderate-to-severe intensity, or worsening with routine activity are required - A diagnosis of migraine without aura needs at least 5 qualifying attacks - Chronic migraine requires headache on 15 or more days a month for more than 3 months [headache] - Tingling limited to one side of the face or a limb is classified as a paraesthesia aura [tingling] SIGNS - what you find (5) - An abnormal neurological exam, such as confusion, neck stiffness, or papilloedema, is a red flag rather than a routine migraine finding [confusion · neck stiffness] - Red flag: an attack running past 72 hours is status migrainosus, not an ordinary attack - Red flag: an aura lasting more than a week with a clean scan is persistent aura without infarction - Red flag: aura together with brain ischaemia on the scan, during an otherwise typical attack, is migrainous infarction [ischaemia] - Red flag: a seizure can be set off by the aura itself [seizures] TESTS (5) - Neuroimaging (CT, MRI, MRA, or MRV) is indicated for a first or worst-ever headache to exclude subarachnoid haemorrhage - Imaging is also indicated for a new headache after age 50 or in an immunosuppressed patient - A headache lasting more than 72 hours, or one not responding to treatment, warrants imaging - The SNOOP checklist (systemic signs, neurological signs, sudden onset, older age, prior pattern change) flags when imaging is needed - Routine spinal fluid analysis and EEG are not needed unless a seizure or infection is suspected IF NOT THIS - what else fits (7) - Tension-type headache is two-sided, lasts 30 minutes to 7 days, and patients usually stay active without other symptoms - Cluster headache is one-sided around the eye or temple, escalates fast, lasts 15 minutes to 3 hours, with tearing, eye redness, or Horner syndrome, often triggered by alcohol - Other differentials with no stated discriminator include a cerebral aneurysm, chronic paroxysmal hemicrania, dissection, encephalitis, subarachnoid bleed, meningitis, and giant cell arteritis - In a child the attack can be abdominal instead of a headache: repeated bouts of abdominal pain, nausea and vomiting - Or short repeated bouts of vertigo, called benign paroxysmal vertigo - Or repeated episodes of the head tilting to one side, benign paroxysmal torticollis - Three quarters of all migraine has no aura at all, so its absence argues nothing Source StatPearls "Migraine Headache" - disease-level clinical article Status traced to the source above Rx: Analgesic - with the triptan, or alone | Triptan | Main treatment | Prevention | Nausea ANALGESIC - WITH THE TRIPTAN, OR ALONE - choose one 1. IBUPROFEN [1st line] Adult 400-800 mg at onset of migraine aura or headache - single-dose Peds 10 mg/kg (max 400 mg) at onset in children 3 months to 11 years; 200-400 mg in adolescents >=12 years Choice Alternatives among the analgesics. NICE CG150 1.3.10 offers a triptan together with an NSAID or paracetamol; ibuprofen is the cheapest of the three and the most studied in migraine. Source Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) Why NSAID used as first-line abortive therapy, taken as early as possible in an attack to blunt the pain and inflammatory component of migraine. Caution Take early at onset of attack for maximum efficacy. Limit use to <10 days/month to prevent medication overuse headache. Take with food. Contraindicated in third trimester of pregnancy (risk of premature closure of fetal ductus arteriosus). CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. PARACETAMOL [1st line] Adult 1 g at onset, repeated up to four times in 24 hours, maximum 4 g in 24 hours - single- dose, repeated within the attack Peds 15 mg/kg/dose [child max 500 mg] (15 mg/kg per dose, up to four times daily, maximum 60 mg/kg/day. CG150 covers people aged 12 and over; below that, treat as paediatric headache. Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why NICE CG150 puts paracetamol in acute migraine twice: 1.3.10 offers an oral triptan plus paracetamol as combination therapy, and 1.3.11 lists paracetamol among the monotherapy options. The Egyptian EML lists paracetamol under antimigraine medicines for treatment of the acute attack. The dose is the MSF drug reference's. Caution Take it at the onset of the attack - late dosing works poorly. Limit acute treatment to fewer than 10-15 days a month or it causes medication overuse headache. The option when ibuprofen is not - it carries no asthma or peptic-ulcer risk, and on pregnancy MSF Essential Drugs 2024 is explicit: it records no contra-indication in pregnancy at all. That is the source's own position, not an unqualified safety claim. Check other products for paracetamol content, especially combination migraine sachets. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 3. ACETYLSALICYLIC ACID [1st line] Adult 900 mg (three 300 mg tablets) as a single dose at onset of the attack - single-dose Peds Do not give aspirin to anyone under 16 years - Reye's syndrome. CG150 covers ages 12 and over, but for aspirin the paediatric prohibition takes precedence. Source Egyptian National Drug Formulary - Cardiovascular 2024 (acetylsalicylic acid monograph), "Migraine, acute treatment ... IR Oral tablet: 900 mg or 1 g once", which also lists the 300 mg tablet strength, corroborated by Migraine Headache - StatPearls (NCBI Bookshelf NBK560787) - https://www.ncbi.nlm.nih.gov/books/NBK560787/: "Ibuprofen (400-600 mg), naproxen (275-825 mg), diclofenac (65 mg), aspirin (900-1000 mg), or acetaminophen (1000 mg)." Why NICE CG150 1.3.11 names aspirin 900 mg as a monotherapy option for the acute treatment of migraine, with the dose written into the recommendation. The Egyptian EML lists acetylsalicylic acid 300 mg and 500 mg tablets under antimigraine medicines for the acute attack. It is cheap and it is everywhere in Egypt. Caution Not under 16 years - Reye's syndrome. Same NSAID cautions as ibuprofen: avoid in asthma, active peptic ulcer or GI bleeding, and renal impairment. Avoid in the third trimester of pregnancy. Limit acute treatment to fewer than 10-15 days a month to avoid medication overuse headache. 900 mg is three 300 mg tablets or two 500 mg tablets rounded down - say the tablet count out loud when prescribing. Egypt ASPOCID 300 MG 200 TABS. CID 80.00 EGP (0.40/unit) TRIPTAN 4. SUMATRIPTAN [1st line] Adult A single 50 mg tablet at onset; some patients may require 100 mg. If the first dose does not work, do NOT take a second for the same attack - treat that attack with paracetamol, aspirin or an NSAID instead. If it worked and the headache comes back, a second dose may be given after a minimum interval of 2 hours. No more than 300 mg in any 24 hours. - Per attack - the label says it must not be used prophylactically Peds Not for children on this label: efficacy and safety are not established under 10 years, and in 10 to 17 year olds the label says use is not recommended. Source Sumatriptan 50mg Tablets SmPC sections 4.1-4.2 (eMC product 524) Why 5-HT1 receptor agonist (triptan) that constricts cranial vessels and dampens neurogenic inflammation in the trigeminovascular pathway; used for attacks not controlled by simple analgesics. Caution In mild to moderate hepatic insufficiency the label says to consider a lower dose of 25-50 mg. Contraindicated in ischemic heart disease or uncontrolled HTN. Do not take within 24h of ergotamine or another triptan. CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline. There is a risk of serotonin syndrome when combined with SSRIs. Egypt IMIGRAN 50MG 2 F.C. TAB. GLAXO SMITHKLINE 35.00 EGP (17.50/unit) MAIN TREATMENT 5. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Migraine Headache - disease-level clinical article (migraine-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Watch for sudden onset severe headache ('worst headache of life') or headache awakening the patient from sleep. PREVENTION - choose one 6. PROPRANOLOL [2nd line] Adult 40 mg BID for prophylaxis, titrate to 80-160 mg daily - long-term Peds Specialist use for pediatric migraine prophylaxis Choice Alternatives. NICE CG150 1.3.18 names propranolol, amitriptyline and topiramate together; propranolol is the cheapest and topiramate must be avoided in a woman who could become pregnant. Source Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) Why Non-selective beta-blocker used for migraine prophylaxis to reduce attack frequency, distinct from the abortive agents used once an attack has started. Caution Contraindicated in asthma, COPD, and second/third-degree AV block. Do not withdraw abruptly. May mask symptoms of hypoglycemia in diabetic patients. CG150 names this drug for migraine but prints no dose for it - the milligram figure here comes from the product label, not the guideline. Egypt INDOLOL 40 MG 50 TAB KAHIRA 13.50 EGP (0.27/unit) PROLOL 40 MG 50 TABS. EIPICO 70.00 EGP (1.40/unit) INDERAL 40 MG 50 TABS ASTRA ZENECA 100.00 EGP (2.00/unit) 7. AMITRIPTYLINE [2nd line] Adult 10-25 mg once daily at bedtime for prophylaxis, titrate up to 50-75 mg - long-term Peds Specialist use for refractory pediatric migraine Source Amitriptyline 25 mg Film-Coated Tablets SmPC section 4.2 (eMC product 13683) Why Tricyclic antidepressant used at low dose for its effect on central pain-modulating pathways, an alternative prophylactic agent for reducing migraine frequency. Caution Amitriptyline has anticholinergic side effects (dry mouth, sedation, urinary retention). Caution in cardiac disease or history of arrhythmias. May take 4-8 weeks to demonstrate prophylactic efficacy. The label puts the usual range at 25-75 mg nightly and says doses above 100 mg should be used with caution. Avoid in elderly patients, and in severe cardiovascular disease or arrhythmias. Amitriptyline - StatPearls - NCBI Bookshelf (NBK537225) puts amitriptyline on the American Geriatrics Society's Beers list, to be avoided in the elderly because its anticholinergic effect is so strong. Egypt TRYPTIZOL 25 MG 30 TABS. KAHIRA 33.00 EGP (1.10/unit) GRANITYLLIN 25MG/5ML SYP. 120 ML GRAND PHARMA ... 5.00 EGP -> ? strength differs, ? different route - not oral solid ZINOTRAVAL 25MG/5ML SYP. 120 ML DEBEIKY > PHA... 10.00 EGP -> ? strength differs, ? different route - not oral solid 8. TOPIRAMATE [2nd line] Adult 25 mg nightly for one week, increased by 25 mg/day at weekly intervals to 100 mg/day in two divided doses; up to 200 mg/day may be tolerated - long-term, withdrawn gradually by 25-50 mg a week Peds 12 years and over: The adult titration. The formulary's paediatric mg/kg schedules are for epilepsy, not migraine. (Licensed for migraine prophylaxis from 12 years, using the adult titration. The formulary's paediatric mg/kg schedules are for epilepsy, not migraine, and cannot be applied here.) Source Egyptian National Drug Formulary - Nervous System Disorders 2025 (topiramate monograph) Why NICE CG150 1.3.18 puts topiramate alongside propranolol and amitriptyline as one of the three drugs to consider for migraine prevention, and the Egyptian formulary carries migraine prophylaxis from 12 years as a licensed indication with a full titration schedule. The entry currently offers only two of the three - which matters most for the asthmatic patient, where propranolol is contraindicated. Caution Do NOT use for migraine prophylaxis in pregnancy, or in a woman who could become pregnant unless a pregnancy prevention programme is in place - NICE CG150 states this alongside recommendation 1.3.18, and the Egyptian formulary says avoid in pregnancy because of major congenital malformations including cleft lip and palate and fetal growth restriction. Do a pregnancy test before starting. It also reduces the effectiveness of hormonal contraceptives - check the method before you write it. Acute myopia with secondary angle-closure glaucoma, usually within the first month: sudden blurred vision or eye pain means stop the drug and refer the same day. Metabolic acidosis, kidney stones, weight loss and cognitive slowing. Monitor serum bicarbonate and weight. Antiepileptics raise the risk of suicidal ideation - ask about mood at review. Withdraw gradually, by 25-50 mg a week, not abruptly. Useful where propranolol is contraindicated - asthma, COPD, heart block - which is a common reason to need it. Egypt EPIMATE 25 MG 10 CAPS. SEDICO 9.50 EGP (0.95/unit) SPRINKAZEN 25MG SPRINKLE 10 CAPS. MEDIZEN PHARMACEUTICAL IND... 10.00 EGP (1.00/unit) CONVIBAN 25 MG 30 F.C. TABS MARCYRL PHARM... 39.00 EGP (1.30/unit) NANCYDAL 25MG 10 F.C. TABS. MEDIZEN PHARM... 13.20 EGP (1.32/unit) DELPIRAMATE 25 MG 10 F.C.TABS. DELTA PHARMA 18.50 EGP (1.85/unit) TOPILEPT 25 MG 30 F.C.TAB. UNIPHARMA CO.... 55.50 EGP (1.85/unit) TOPIRAMATE 25MG 30 F.C.TAB. SABAA 90.00 EGP (3.00/unit) TOPAMAX 25 MG 60 F.C. TABS. JANSSEN CILAG... 246.00 EGP (4.10/unit) CONVIBAN 25MG/ML SYRUP 120 ML MARCYRL PHARM... 52.50 EGP -> ? strength differs, ? different route - not oral solid NAUSEA - give alongside 9. METOCLOPRAMIDE [add-on - not a substitute] Adult 10 mg at onset, repeated up to three times daily; maximum 30 mg in 24 hours, maximum 5 days - within the attack, no more than 5 days Peds Not for migraine nausea in children. The Egyptian formulary's paediatric indications are post-operative and chemotherapy-induced nausea only, second line, from 1 year, and extrapyramidal reactions are commonest in children and young adults. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (metoclopramide monograph) Why NICE CG150 1.3.13 says to consider an anti-emetic in addition to other acute treatment for migraine even in the absence of nausea and vomiting, and 1.3.14 names metoclopramide by name where oral preparations fail. The Egyptian formulary's own oral adult indication is 'symptomatic treatment of nausea and vomiting, including acute migraine-induced nausea and vomiting'. Nausea is what stops the triptan being absorbed - this is the row that makes the rest of the prescription work. Caution NICE says to consider an anti-emetic even when there is no nausea - it improves the absorption of the acute treatment. Maximum 5 days and maximum 30 mg a day. Beyond that the risk of tardive dyskinesia rises. Extrapyramidal reactions - acute dystonia - are commonest in children, adolescents and young women. Warn the patient. Keep at least 6 hours between doses even if a dose is vomited back. Halve the dose if creatinine clearance is 15-60 mL/min, and reduce by three quarters below 15. Egypt CLOPRAM 10MG 20 TAB. EL NASR 3.00 EGP (0.15/unit) PLEMAZOL 10MG 20 TAB. CID 3.20 EGP (0.16/unit) VOMAWAY 10MG 20 TAB. MEMPHIS 8.50 EGP (0.42/unit) PRIMPERAN 10MG 10 SCORED TAB. SANOFI 10.50 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)