From the Guidelines
First-line medications for migraine include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600 mg) or naproxen sodium (500-550 mg), and triptans such as sumatriptan (50-100 mg orally, 4-6 mg subcutaneously, or 20 mg intranasally) 1. These medications should be taken at the first sign of migraine symptoms for best effectiveness. NSAIDs work by reducing inflammation and pain by inhibiting prostaglandin synthesis, while triptans activate serotonin receptors to constrict blood vessels and block pain pathways in the brain. For frequent migraines (more than 4 days per month), preventive medications may be considered, including propranolol (80-240 mg daily), amitriptyline (30-150 mg daily), divalproex sodium (500-1500 mg/d), and sodium valproate (800-1500 mg/d) 1. The choice between these medications depends on the patient's migraine pattern, comorbidities, and previous treatment responses. Some key points to consider when treating migraines include:
- Taking medication early in an attack
- Staying hydrated
- Resting in a dark, quiet room
- Considering combination therapy or second-line options if first-line treatments fail
- Educating patients about their treatment options and involving them in the management plan 1.
From the FDA Drug Label
Eletriptan hydrobromide tablets are indicated for the acute treatment of migraine with or without aura in adults. The FDA drug label does not answer the question of what medications are first line for migraine, it only mentions that eletriptan hydrobromide tablets are used for the acute treatment of migraine. Other medications such as almotriptan (Axert®), frovatriptan (Frova®), naratriptan (Amerge®), rizatriptan (Maxalt®), sumatriptan and naproxen sodium, (Treximet®), zolmitriptan (Zomig®), and sumatriptan (Imitrex®) are mentioned as similar medications, but it is not specified if they are first line treatments 2, 2.
From the Research
First-Line Medications for Migraine
The following medications are considered first-line treatments for migraine:
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild to moderate migraines 3
- Triptans, such as sumatriptan, rizatriptan, eletriptan, zolmitriptan, almotriptan, frovatriptan, and naratriptan, for moderate to severe migraines 4, 3, 5, 6, 7
Specific First-Line Medications
Some specific first-line medications for migraine include:
- Ibuprofen, naproxen sodium, diclofenac potassium, and acetylsalicylic acid (NSAIDs) 5
- Eletriptan, which has been shown to be effective in the acute treatment of moderate to severe migraine attacks 6, 7
Treatment Strategies
Treatment strategies for migraine can be organized into different approaches, including:
- The acetaminophen-NSAID strategy for patients with mild to moderate attacks 5
- The triptan strategy for patients with severe attacks or those who do not respond well to NSAIDs 5
- The refractory migraine strategy, which may include using triptans and NSAIDs simultaneously, dihydroergotamine, or rescue medications 5