A 60-year-old severely medically compromised woman presented with three to four left-sided migraines per week. A hollow metal tube filled with circulating ice water was held against an intraoral tender area associated with an accessible left maxillary nerve segment. This local chilling eliminated the headaches, replacing more than five Imitrex tablets per week. When the headaches returned 17 months later, daily topical application of Ketoprofen compounded with organogel to create a gel, was applied to the same area with equal effectiveness. After a kidney transplant several months later, the patient was placed on high doses of steroids, and no longer required the topical NSAID for headache prevention. Two systemic medications and two local antiinflammatory treatments with minimal side effects were effective for migraine prevention in this patient. The treatments described here demonstrate the possibility of local treatment which would particularly benefit the medically compromised patient.
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