Pre Treatment Migraine Headache Questionnaire Page 4
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425. Have you used past prescription treatments such as: (Check all that apply)
Tricyclics (Amitriptyline, Nortiptyline)
Beta Blockers (Inderal)
Anti-Seizure (Topamax, Gabapentin, Neurontin)
BOTOX
Calcium Channel Blockers (Verapamil)
Supplements (list all including magnesium)_____________________________________
26. Have you used any rescue medications such as: (Check all that apply):
Triptans (Imitrex, Maxalt)
DHE
Nonsteroidals
Combinations (Fiorinal, Midrin, Excedrin)
Antinausea (Phenergan, Reglan)
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