Migraine Treatment in Patients with Thrombocytosis

Contraindications and Precautions

The American College of Cardiology recommends that sumatriptan is absolutely contraindicated in patients with ischemic vascular disease, including those with prior cerebrovascular events, regardless of platelet count 1
Patients with thrombocytosis secondary to myeloproliferative disorders may have increased cardiovascular risk and should be evaluated for underlying vascular disease before prescribing triptans, according to the American Heart Association 1

The American Academy of Neurology recommends starting with NSAIDs (ibuprofen 400-800 mg, naproxen 500-825 mg) plus acetaminophen 1000 mg for mild to moderate migraine, with a strength of evidence rated as high 2, 3
The American Headache Society suggests adding a triptan (sumatriptan 50-100 mg) to the NSAID regimen for moderate to severe attacks, with a strength of evidence rated as moderate 2, 3
The American College of Physicians recommends using CGRP antagonists (gepants: ubrogepant 50-100 mg, rimegepant, or zavegepant) as alternative agents if triptans are contraindicated, with a strength of evidence rated as high 2, 1

The American Academy of Neurology recommends restricting all acute migraine medications to no more than 2 days per week to prevent medication-overuse headache, with a strength of evidence rated as high 2, 3