| 01 |
Tylenol (or other brand of acetaminophen) |
|
|
Tylenol (or other brand of acetaminophen) |
| 02 |
Aleve/Naprosyn/Anapox (or other bran of naproxen) |
|
|
Aleve/Naprosyn/Anapox (or other bran of naproxen) |
| 03 |
Aspirin |
|
|
Aspirin |
| 04 |
Excedrin/Excedrin Migraine/Generic Excedrin (acetominophen+aspirin+caffeine) |
|
|
Excedrin/Excedrin Migraine/Generic Excedrin (acetominophen+aspirin+caffeine) |
| 05 |
Advil, Motrin (or other brand of ibuprofen) |
|
|
Advil, Motrin (or other brand of ibuprofen) |
| 06 |
Orudis/Oruvail (ketoprofen) |
|
|
Orudis/Oruvail (ketoprofen) |
| 07 |
Other non prescriptions, specify |
|
|
Other non prescriptions, specify |
| 08 |
Other non prescriptions, specify |
|
|
Other non prescriptions, specify |
| 09 |
Amerge tablets (naratriptan) |
|
|
Amerge tablets (naratriptan) |
| 10 |
Axert tablets (almotriptan) |
|
|
Axert tablets (almotriptan) |
| 11 |
Demerol (oral or injected meperidine) |
|
|
Demerol (oral or injected meperidine) |
| 12 |
Ergomar/Bellergal-S/Cafergot (or other brand of ergotamine) |
|
|
Ergomar/Bellergal-S/Cafergot (or other brand of ergotamine) |
| 13 |
Fiorinal/Fioricet (butalbital+caffeine+acetaminophin) with or without codeine |
|
|
Fiorinal/Fioricet (butalbital+caffeine+acetaminophin) with or without codeine |
| 14 |
Frova tablets (frovatriptan) |
|
|
Frova tablets (frovatriptan) |
| 15 |
Imitrex tablets (sumatriptan) |
|
|
Imitrex tablets (sumatriptan) |
| 16 |
Imitrex nasal spray (sumatriptan) |
|
|
Imitrex nasal spray (sumatriptan) |
| 17 |
Imitrex STAT dose (injection) (sumatriptan) |
|
|
Imitrex STAT dose (injection) (sumatriptan) |
| 18 |
Midrin/Duradrin (Isometheptene+dichoralphenazone+acetaminophen) |
|
|
Midrin/Duradrin (Isometheptene+dichoralphenazone+acetaminophen) |
| 19 |
Maxalt MLT (oral wafer) (rizatriptan) |
|
|
Maxalt MLT (oral wafer) (rizatriptan) |
| 20 |
Maxalt tablets (riztriptan) |
|
|
Maxalt tablets (riztriptan) |
| 21 |
Migranal nasal spray or DHE-45 injection (dihydroergotamine) |
|
|
Migranal nasal spray or DHE-45 injection (dihydroergotamine) |
| 22 |
Oral narcotics (Darvocet, Tylenol with codeine, Vicodin, Vicoprofen) |
|
|
Oral narcotics (Darvocet, Tylenol with codeine, Vicodin, Vicoprofen) |
| 23 |
Phrenilin (butalbital+acetaminoophen) |
|
|
Phrenilin (butalbital+acetaminoophen) |
| 24 |
Relpax tablets (eletriptan) |
|
|
Relpax tablets (eletriptan) |
| 25 |
Zomig nasal spray (zolmitriptan) |
|
|
Zomig nasal spray (zolmitriptan) |
| 26 |
Stadol NS (nasal spray) (butorphanol) |
|
|
Stadol NS (nasal spray) (butorphanol) |
| 27 |
Toradol (ketorolac) other non-narcotic |
|
|
Toradol (ketorolac) other non-narcotic |
| 28 |
Zomig tablet (zolmitriptan) |
|
|
Zomig tablet (zolmitriptan) |
| 29 |
Zomig ZMT (melt) (zolmitriptan) |
|
|
Zomig ZMT (melt) (zolmitriptan) |
| 30 |
Any other injected pain reliever specify |
|
|
Any other injected pain reliever specify |
| 31 |
Other prescription specify |
|
|
Other prescription specify |