What are the prescription treatments for migraines diagnosed through physical examination?

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From the Guidelines

For the treatment of migraines, first-line prescription treatments include triptans such as sumatriptan (25-100mg orally at onset, repeatable after 2 hours if needed) or rizatriptan (5-10mg), as well as aspirin-acetaminophen-caffeine, which are recommended based on strong evidence 1. When considering preventive therapy, the most recent guidelines recommend candesartan, telmisartan, erenumab, fremanezumab, or galcanezumab for the prevention of episodic or chronic migraine, with a strong recommendation 1. Key points to consider in the management of migraines include:

  • A thorough physical examination to identify potential triggers and rule out other causes of headache
  • The use of triptans, aspirin-acetaminophen-caffeine, or other recommended medications for acute treatment
  • The consideration of preventive therapy in patients with frequent or severe migraines
  • The potential benefits and risks of different medications, including anti-CGRP monoclonal antibodies, beta-blockers, and topiramate Some medications, such as propranolol, topiramate, and valproate, are suggested for preventive therapy, but with weaker evidence 1. It is essential to individualize treatment based on patient-specific factors, including medical history, medication tolerance, and lifestyle. In terms of acute treatment, medications such as eletriptan, frovatriptan, rizatriptan, sumatriptan, and zolmitriptan are recommended, with strong evidence 1. Additionally, medications like acetaminophen, aspirin, ibuprofen, and naproxen may be suggested for acute treatment, but with weaker evidence 1. Overall, the management of migraines requires a comprehensive approach, incorporating physical examination, patient education, and evidence-based medication therapy.

From the FDA Drug Label

Sumatriptan tablets are a prescription medicine used to treat acute migraine headaches with or without aura in adults The prescription treatment for migraines is sumatriptan tablets.

  • Key points:
    • Sumatriptan tablets are used to treat acute migraine headaches with or without aura in adults.
    • A physical exam is required for people with risk factors for heart disease before taking sumatriptan tablets.
    • Sumatriptan tablets are not used to prevent or decrease the number of migraine headaches.
    • It is not known if sumatriptan tablets are safe and effective to treat cluster headaches.
    • Sumatriptan tablets are not used to treat other types of headaches such as hemiplegic or basilar migraines. 2

From the Research

Physical Exam for Migraines

  • A physical exam is essential in evaluating headaches to determine whether they are primary or secondary headache disorders 3
  • The physical examination can help identify extracranial origins of migraine headache, such as pain coming from the muscles of the head and neck 4
  • Techniques of physical examination can help identify the causes of migraine headache and lead to physical treatment, reducing headache frequency and severity 4

Prescription Treatment for Migraines

  • Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 5
  • Migraine-specific treatments include triptans (5-HT1B/D agonists), which can eliminate pain in 20% to 30% of patients by 2 hours, but are accompanied by adverse effects 5
  • Other acute treatments include gepants, antagonists to receptors for the inflammatory neuropeptide calcitonin gene-related peptide, such as rimegepant or ubrogepant, and a 5-HT1F agonist, lasmiditan 5
  • Preventive treatments include antihypertensives, antiepileptics, antidepressants, calcitonin gene-related peptide monoclonal antibodies, and onabotulinumtoxinA, which can reduce migraine by 1 to 3 days per month relative to placebo 5

Triptans for Migraine Treatment

  • Triptans are a class of compounds developed for the treatment of migraine attacks, with sumatriptan being the first of the class 6
  • Different sumatriptan formulations are available, including subcutaneous, intranasal, transdermal, oral, and suppository options, each with different pharmacokinetic, efficacy, and adverse event profiles 7
  • The choice of triptan formulation depends on the severity of the migraine attack and the patient's response to initial treatment 7
  • Comparative studies of triptans have shown minor differences in efficacy, with subcutaneous sumatriptan having the highest therapeutic gain 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Headaches in Adults in Primary Care: Evaluation, Diagnosis, and Treatment.

The Medical clinics of North America, 2021

4
Research

The physical examination of migraine.

Current pain and headache reports, 2006

7
Research

Sumatriptan : treatment across the full spectrum of migraine.

Expert opinion on pharmacotherapy, 2013

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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