From the Guidelines
Migraine symptoms should be treated with a combination therapy of a triptan and an NSAID or acetaminophen as soon as possible after onset, and patients who do not tolerate or have inadequate response to this treatment may be considered for lasmiditan. Migraine symptoms typically include a throbbing or pulsating headache, often on one side of the head, that can last from 4 to 72 hours. Common accompanying symptoms include nausea, vomiting, sensitivity to light (photophobia), sensitivity to sound (phonophobia), and sensitivity to smells. Some people experience an aura before the headache begins, which may involve visual disturbances like flashing lights, zigzag lines, or temporary vision loss, as well as sensory changes, speech difficulties, or weakness. Other symptoms can include fatigue, dizziness, difficulty concentrating, and neck pain. Some migraines are preceded by prodrome symptoms like mood changes, food cravings, or increased thirst occurring hours or days before the headache. After the headache subsides, a postdrome phase may occur with symptoms of fatigue, difficulty concentrating, and mild head pain with sudden movement. Key considerations for treatment include:
- Counseling patients to begin treatment of migraine headache as soon as possible after its onset, using combination therapy to improve efficacy 1
- Considering the use of a nonoral triptan and an antiemetic in people having severe nausea or vomiting 1
- Avoiding the use of opioids or butalbital for the treatment of acute episodic migraine 1
- Discussing the potential adverse effects of pharmacologic treatments during pregnancy and lactation with patients of childbearing potential 1
- Highlighting the importance of lifestyle modifications, including staying well hydrated, maintaining regular meals, securing sufficient and consistent sleep, engaging in regular physical activity, managing stress, and pursuing weight loss for those who are overweight or obese 1
From the Research
Migraine Symptoms
Migraine is a primary headache disorder characterized by recurrent attacks 2. The symptoms of migraine can vary from person to person, but common symptoms include:
- Recurrent headache attacks
- Sensitivity to light and sound
- Nausea and vomiting
- Dizziness and vertigo
Treatment Options
There are several treatment options available for migraine, including:
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild to moderate migraines 2, 3
- Triptans for moderate to severe migraines 2, 3
- Antiemetics and ergot alkaloids for select patients or for those with refractory migraine 2
- Dihydroergotamine (DHE) for selected patients 3
- Calcitonin gene-related peptide receptor antagonists, lasmiditan, and nonpharmacologic treatments such as remote electrical neuromodulation and transcranial magnetic stimulation 4
Lifestyle Factors
Lifestyle factors can also play a role in migraine management, including:
- Stress management 5
- Sleep and physical activity 5, 6
- Diet and nutrition 5, 6
- Avoidance of drug abuse 6
- Management of obesity 6
Acute Treatment Strategies
Acute treatment strategies for migraine can be organized into four treatment strategies:
- The acetaminophen-NSAID strategy for patients with attacks of mild to moderate severity 3
- The triptan strategy for patients with severe attacks and for those with attacks of moderate severity who do not respond well to NSAIDs 3
- The refractory migraine strategies for patients who do not respond well to NSAIDs or triptans alone 3
- Strategies for patients with contraindications to vasoconstricting drugs, including use of NSAIDs, combination analgesics, and dopamine antagonists 3