From the Guidelines
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine are the first-line therapy for most migraine sufferers. When choosing a first-line treatment for migraines, it is essential to consider the patient's specific needs and symptoms. Some key points to consider when selecting a first-line treatment include:
- The patient's medical history and any potential contraindications to certain medications
- The severity and frequency of the patient's migraines
- The presence of any aura or other symptoms that may affect treatment choices
- The patient's preferences and lifestyle, including any potential side effects or interactions with other medications. According to the study 1, NSAIDs are the most consistent evidence-based first-line therapy for migraines, with options including aspirin, ibuprofen, naproxen sodium, tolfenamic acid, and the combination agent acetaminophen plus aspirin plus caffeine. In patients whose migraine attack has not responded to NSAIDs, migraine-specific agents such as triptans (e.g., oral naratriptan, rizatriptan, and zolmitriptan) or DHE (e.g., nasal spray) may be considered 1. Additionally, preventive therapy should be evaluated for patients with frequent migraines (more than 4 days per month), with first-line options including propranolol, timolol, or amitriptyline 1. It is crucial to individualize treatment and consider the patient's unique needs and circumstances when selecting a first-line treatment for migraines.
From the FDA Drug Label
The recommended dose of sumatriptan tablets is 25 mg, 50 mg, or 100 mg. Doses of 50 mg and 100 mg may provide a greater effect than the 25 mg dose, but doses of 100 mg may not provide a greater effect than the 50 mg dose. The efficacy of sumatriptan tablets in the acute treatment of migraine headaches was demonstrated in 3, randomized, double-blind, placebo-controlled trials. In all 3 trials, the percentage of patients achieving headache response 2 and 4 hours after treatment was significantly greater among patients receiving sumatriptan tablets at all doses compared with those who received placebo
First line treatment for migraines is sumatriptan tablets, with a recommended dose of 25 mg, 50 mg, or 100 mg 2. The dose can be repeated after at least 2 hours if the migraine has not resolved or returns after a transient improvement, with a maximum daily dose of 200 mg in a 24-hour period 2.
- Key points:
From the Research
First-Line Treatment for Migraines
- Triptans are considered the first-line treatment for moderate-to-severe migraine headaches 3, 4, 5, 6, 7
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatments for mild to moderate migraines 5, 6, 7
- Sumatriptan, a triptan, is available in different formulations, including subcutaneous, intranasal, transdermal, oral, and suppository options 3
Treatment Strategies
- A stratified treatment approach can help ensure that migraine treatment is cost-effective 5
- The administration of acute medications should follow the concept of "stratified care" 6
- For mild to moderate migraine attacks, oral NSAIDs are the first choice; with oral aspirin, combination analgesics, intravenous/intramuscular NSAIDs as alternatives 6
- For moderate to severe attacks, oral or nasal spray triptans and ergotamine/caffeine compounds are recommended and should be administered in the early stage of migraine attacks 6
Medication Options
- NSAIDs and triptans are the mainstays of acute migraine therapy, and antiemetic drugs can be added as necessary 7
- Dihydroergotamine (DHE) is also suitable for selected patients 7
- Opioids and combination analgesics containing opioids should not be used routinely 7
- Acetaminophen is the safest acute migraine drug during pregnancy, and acetaminophen with codeine is also an option 7