From the Guidelines
The first-line treatment for acute migraine attacks typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) or triptans, with the choice of specific medication based on individualized decision making, taking into consideration patient preferences and factors such as route of administration and cost. For mild episodic migraine headache, consider treating with an NSAID, acetaminophen, or the combination of an NSAID and acetaminophen 1. Some key options include:
- NSAIDs like aspirin, celecoxib, diclofenac, ibuprofen, or naproxen
- Triptans such as almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, or zolmitriptan
- CGRP antagonists-gepants (rimegepant, ubrogepant, or zavegepant) or ergot alkaloid (dihydroergotamine) for moderate to severe acute episodic migraine headache in nonpregnant outpatient adults who do not tolerate or have inadequate response to combination therapy of a triptan and an NSAID or acetaminophen 1. It's also important to consider using a nonoral triptan and an antiemetic in people having severe nausea or vomiting, and to counsel patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1. Additionally, patients should be aware of medication overuse headache, which is a potential complication of migraine treatment, and preventive medications may be warranted if the episodic migraine occurs frequently or treatment does not provide an adequate response 1.
From the Research
Migraine First Line Treatment
- Triptans are considered the first-line treatment for moderate-to-severe migraine headaches 2
- Sumatriptan, a triptan, is available in different formulations, including subcutaneous, intranasal, transdermal, oral, and suppository options 2
- Oral sumatriptan has been shown to be an effective drug for the treatment of a single acute attack of migraine, with a significant improvement in headache relief and functional disability 3
- The choice of sumatriptan formulation depends on the individual patient's needs, with subcutaneous dosing providing the fastest and most complete migraine relief, and oral administration being generally preferred by patients 2
Treatment Options
- Other triptans, such as rizatriptan, eletriptan, and zolmitriptan, are also effective for acute migraine treatment 4, 5
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, are also suitable for acute migraine treatment, especially for mild to moderate attacks 5
- Dihydroergotamine (DHE) is another option for selected patients, especially those with severe attacks 5
Safety and Efficacy
- Sumatriptan is generally well tolerated, with common adverse events including nausea, vomiting, and injection site reactions 2, 6
- Serious adverse events, such as cardiovascular effects, are rare but can occur, and sumatriptan is contraindicated in patients with a history of cardiovascular disease 6
- The efficacy and safety of sumatriptan have been established in numerous clinical trials, with significant improvements in headache relief, functional disability, and quality of life 3, 6