What is the treatment for migraine?

From the Guidelines

The primary treatment for migraine involves a combination of acute pain relief and preventive measures, with nonsteroidal anti-inflammatory drugs (NSAIDs) being the first-line therapy for most migraine sufferers.

Acute Treatment

• Start with over-the-counter pain relievers like ibuprofen (400-600 mg) or naproxen (500-550 mg) at the first sign of migraine, as recommended by 1.
• If ineffective, use triptans such as sumatriptan (50-100 mg orally) or rizatriptan (5-10 mg orally), which have shown good evidence of efficacy in the prevention of migraine headache 1.
• For severe nausea, add an antiemetic like metoclopramide (10 mg) or ondansetron (4-8 mg).

Preventive Treatment

• Beta-blockers: propranolol (20-80 mg twice daily) or metoprolol (50-100 mg twice daily) have consistently shown efficacy in the prevention of migraine, as noted in 1.
• Antiepileptics: topiramate (25-100 mg twice daily) or valproic acid (250-500 mg twice daily) may also be considered for preventive treatment.
• Calcium channel blockers: verapamil (80-160 mg three times daily) can be used, but the evidence is limited.

Non-Pharmacological Approaches

• Identify and avoid triggers (e.g., certain foods, stress, lack of sleep)
• Practice stress-reduction techniques like meditation or yoga
• Maintain a regular sleep schedule
• Stay hydrated and eat regular meals Combining pharmacological treatment with lifestyle modifications often provides the best outcomes for migraine management, as suggested by 1 and 1.

From the FDA Drug Label

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 Propranolol hydrochloride extended-release capsules are indicated for the prophylaxis of common migraine headache

The treatment for migraine is sumatriptan for acute treatment, as it has been shown to be effective in reducing headache severity. Propranolol is used for the prophylaxis of common migraine headache, but not for the treatment of an acute migraine attack 2 3.

From the Research

Treatment Options for Migraine

The treatment for migraine includes the use of triptans, with sumatriptan being a commonly used medication 4, 5, 6, 7, 8.

• Sumatriptan Formulations: Sumatriptan is available in different formulations, including subcutaneous, intranasal, transdermal, oral, and suppository options 4.
• Efficacy and Tolerability: The fastest and most complete migraine relief occurs with subcutaneous dosing, while oral administration is generally preferred by patients, although variability with absorption limits efficacy, especially for more severe attacks 4, 8.
• Dosing and Administration: Reducing the subcutaneous dose to 3 mg has significantly better tolerability with high response rates and freedom from pain within 2 hours 6.
• Comparison with Other Treatments: Sumatriptan has been shown to be more effective than other antimigraine treatments, including ergotamine + caffeine, and has similar efficacy to other triptans, such as naratriptan and rizatriptan 5, 7.
• Adverse Events: Adverse events are more common with subcutaneously administered sumatriptan and higher doses of oral and intranasal sumatriptan, but are generally of mild or moderate severity and short duration 5, 7, 8.

Route of Administration

The route of administration influences the efficacy of sumatriptan, particularly within the first hour after administration 8.

• Subcutaneous Administration: Subcutaneous administration is the most effective, with pain reduced from moderate or severe to none by two hours in almost 6 in 10 people taking 6 mg sumatriptan 8.
• Oral Administration: Oral administration provides clinically useful pain relief, with the oral 50 mg dose providing complete relief of pain in almost 3 in 10 people compared with about 1 in 10 after placebo 8.
• Intranasal and Rectal Administration: Intranasal and rectal administration also provide pain relief, with the most effective dose for each route of administration being intranasal 20 mg and rectal 25 mg 8.