In cardiovascular disease, gepants are likely safe for acute therapy; NSAIDs, ergotamines, and triptans are not recommended. Beta-blockers, ACEi/ARBs, and verapamil have potential cardiovascular benefits in addition to migraine preventive benefit. Frovatriptan requires no dose adjustments in kidney disease or in mild to moderate liver disease. Gepants are safe acute and preventive treatment options in mild and moderate renal and hepatic disease. TCAs and valproic acid require no dose adjustments in renal disease. OnabotulinumtoxinA is likely safe in cardiac, renal, and hepatic impairment. Although CGRP monoclonal antibodies are likely safe in renal and hepatic disease, further study is needed in these conditions as well as in cardiac disease, and no dosing recommendations are available. Effective options are available for those with complex medical comorbidities. Further research is required on the safety of newer migraine-specific therapies in these complex populations.
Keyphrases
- cardiovascular disease
- liver failure
- end stage renal disease
- healthcare
- left ventricular
- respiratory failure
- ejection fraction
- stem cells
- newly diagnosed
- peritoneal dialysis
- risk assessment
- metabolic syndrome
- high intensity
- intensive care unit
- mesenchymal stem cells
- angiotensin converting enzyme
- cell therapy
- extracorporeal membrane oxygenation
- mechanical ventilation